Primary cutaneous marginal zone lymphomas with plasmacytic differentiation show frequent IgG4 expression
Primary cutaneous marginal zone lymphomas with plasmacytic differentiation show frequent IgG4 expression
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DOI：
10.1038/modpathol.2013.106
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发表时间：
2013-12-01
期刊：
影响因子：
7.5
通讯作者：
Geissinger, Eva
中科院分区：
文献类型：
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作者：
Brenner, Isabel;Roth, Sabine;Geissinger, Eva
IgG 4在恶性B细胞淋巴瘤中的表达仅被部分研究。最近的报告描述了单个病例的边缘区淋巴瘤发生在眼附属器，表达IgG 4。此外，硬膜相关边缘区淋巴瘤的一个子集似乎也表达IgG 4。我们研究了IgG 4的表达在一个更系统的方式在一个大的队列边缘区淋巴瘤标本来自我们的研究所的档案。总体而言，我们检查了169个边缘区淋巴瘤的各种主要网站，显示了不同的浆细胞分化和轻链限制，允许在这些肿瘤免疫球蛋白重链表达的免疫组织化学的详细调查。出乎意料的是，原发性皮肤边缘区淋巴瘤表现出频繁的IgG 4表达。虽然只有1/120的非皮肤边缘区淋巴瘤，位于眼附属器，表达IgG 4，19/49（39%）的原发性皮肤边缘区淋巴瘤表现出这一特点，构成了最高的表达率IgG 4的任何B细胞淋巴瘤的报告日期。没有一个IgG 4阳性的皮肤边缘区淋巴瘤的临床数据表明，预先存在的全身性IgG 4相关疾病的证据，这表明在疾病的早期阶段的局部免疫IgG 4驱动的发病过程。IgG 4阳性和IgG 4阴性的原发性皮肤边缘区淋巴瘤在浸润的结构特征或反应性T细胞浸润的组成方面没有显著差异，这是通过分析T细胞含量、CD 4/CD 8比率以及FOXP 3和PD 1阳性T细胞的含量来确定的。尽管目前在具有浆细胞分化的原发性皮肤边缘区淋巴瘤的重要亚群中IgG 4表达的发病作用仍不清楚，但在涉及皮肤的边缘区淋巴瘤中IgG 4表达的证明可能是常规诊断环境中的有用线索，因为这些肿瘤几乎总是原发于皮肤，扩散到非皮肤部位的风险极低，预后良好。
The expression of IgG4 in malignant B-cell lymphomas has only partially been studied. Recent reports described single cases of marginal zone lymphomas arising in the ocular adnexae that express IgG4. Moreover, a subset of dura-associated marginal zone lymphomas appear to express IgG4 as well. We investigated IgG4 expression in a more systematic manner in a large cohort of marginal zone lymphoma specimens derived from the archive of our institute. Overall, we examined 169 marginal zone lymphomas of various primary sites that displayed a distinct plasmacytic differentiation and light chain restriction, allowing for a detailed investigation of the immunoglobulin heavy chain expression in these tumors by immunohistochemistry. Unexpectedly, primary cutaneous marginal zone lymphomas showed frequent IgG4 expression. Although only 1 out of 120 noncutaneous marginal zone lymphomas, located in the ocular adnexae, expressed IgG4, 19 of 49 (39%) primary cutaneous marginal zone lymphomas showed this feature, constituting the highest expression rate of IgG4 reported to date in any B-cell lymphoma. None of the IgG4-positive cutaneous marginal zone lymphomas with available clinical data showed evidence of a preexisting systemic IgG4-related disease, suggesting a localized immunologic IgG4-driven pathogenetic process at early stages of the disease. IgG4-positive and IgG4-negative primary cutaneous marginal zone lymphomas did not significantly differ in architectural features of the infiltrate or the composition of the reactive T-cell infiltrate as determined by analysis of T-cell content, CD4/CD8 ratio, and content of FOXP3- and PD1-positive T cells. Although the pathogenetic role of IgG4 expression in a significant subset of primary cutaneous marginal zone lymphomas with plasmacytic differentiation remains unclear at present, the demonstration of IgG4 expression in a marginal zone lymphoma involving the skin might be a helpful clue in the routine diagnostic setting, as these tumors will almost invariably be of primary cutaneous origin with an extremely low risk of spread to noncutaneous sites and an excellent prognosis.