A high number of IgG4-positive plasma cells rules out nodular lymphocyte predominant Hodgkin lymphoma
A high number of IgG4-positive plasma cells rules out nodular lymphocyte predominant Hodgkin lymphoma
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DOI：
10.1007/s00428-018-2460-8
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发表时间：
2018-12-01
期刊：
影响因子：
3.5
通讯作者：
Hartmann, Sylvia
中科院分区：
文献类型：
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作者：
Kiil, Kati;Bein, Julia;Hartmann, Sylvia
结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHL）是霍奇金淋巴瘤的一个亚型，经常表现为微环境中具有丰富反应性B细胞的结节生长模式。早期NLPHL病例可能特别难以与进行性转化的老年中心（PTGC）区分。由于PTGC已被描述为在相对较高比例的病例中与IgG 4相关，本研究的目的是确定IgG 4免疫染色是否有助于NLPHL和PTGC之间的鉴别诊断。我们还旨在了解LP细胞是否可以表达IgG 4。为此目的，58例PTGC和56例NLPHL使用IgG 4免疫染色进行了评估。我们可以证实，大量PTGC病例显示大量IgG 4阳性浆细胞（22/58，38%），而在任何NLPHL病例中均未发现IgG 4阳性浆细胞的热点区域。因此，在鉴别诊断为NLPHL和PTGC的淋巴结区域，当遇到大量IgG 4阳性浆细胞时，IgG 4免疫染色可以提供一种有用的诊断工具来排除NLPHL。我们还评估了13例NLPHL和PTGC在同一淋巴结中的组合。其中5例在PTGC区域出现IgG 4阳性浆细胞热点区域，而在淋巴结的NLPHL部分未观察到显著数量的IgG 4阳性浆细胞。LP细胞从未出现IgG 4阳性。此外，分析了单个IgG 4阳性浆细胞的免疫球蛋白重链重排，揭示了多克隆浆细胞群。总之，我们的数据表明，IgG 4免疫染色可以提供额外的信息，在诊断后处理的情况下与NLPHL和PTGC的鉴别诊断。IgG 4清除抗原的效率低下可能解释了为什么PTGC的淋巴结通常强烈肿大并形成大量增生性生发中心。IgG 4阳性浆细胞中的多克隆免疫球蛋白重链重排进一步支持PTGC代表误导性免疫反应的假设。
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a subtype of Hodgkin lymphoma that frequently shows a nodal growth pattern with abundant reactive B cells in the microenvironment. Early NLPHL cases can be particularly difficult to differentiate from progressively transformed germinal centers (PTGC). Since PTGC have been described to be IgG4 associated in a relatively high proportion of cases, the aim of the present study was to determine if IgG4 immunostaining can be helpful in the differential diagnosis between NLPHL and PTGC. We furthermore aimed to learn if LP cells can express IgG4. For this purpose, 58 cases of PTGC and 56 cases of NLPHL were assessed using IgG4 immunostaining. We could confirm that a significant number of PTGC cases showed high numbers of IgG4-positive plasma cells (22/58, 38%), whereas hot spot areas of IgG4-positive plasma cells were not found in any of the NLPHL cases. In lymph node areas with the differential diagnosis of NLPHL and PTGC, IgG4 immunostaining can therefore provide a helpful diagnostic tool to rule out NLPHL when a high number of IgG4-positive plasma cells are encountered. We also assessed 13 cases with a combination of NLPHL and PTGC in the same lymph node. Five of these cases presented hot spot areas of IgG4-positive plasma cells in the PTGC regions, while no significant numbers of IgG4-positive plasma cells were observed in the NLPHL part of the lymph node. LP cells were never IgG4 positive. Furthermore, immunoglobulin heavy chain rearrangements of single IgG4-positive plasma cells were analyzed, revealing a polyclonal plasma cell population. In summary, our data suggest that IgG4 immunostaining can provide additional information in the diagnostic workup of cases with the differential diagnosis of NLPHL and PTGC. IgG4's inefficiency in clearing antigens may explain why lymph nodes with PTGC are usually strongly enlarged and develop a high number of hyperplastic germinal centers. Polyclonal immunoglobulin heavy chain rearrangements in IgG4-positive plasma cells further support the hypothesis that PTGC represent a misled immune reaction.