Salivary duct carcinoma arising in IgG4-related autoimmune disease of the parotid gland

Hum Pathol. 2009 Jun;40(6):881-6. doi: 10.1016/j.humpath.2008.10.020. Epub 2009 Feb 5.

Abstract

Hyper IgG4 disease or IgG4-related sclerosing/autoimmune disease is a multisystem condition characterized histologically by fibrosis, lymphoplasmacytic infiltration, and abundant IgG4 plasma cells associated with raised serum IgG4 levels. We present a case of salivary duct carcinoma of the parotid gland in a background of chronic sclerosing sialadenitis that also involved the submandibular gland with associated regional lymphadenopathy. The serology showed raised total IgG levels of 16.3 g/L (reference range, 6.0-15.0) and raised IgG4 levels of 3.41 g/L (reference range, 0.07-1.70). The salivary duct carcinoma contained areas of dense fibrosis and abundant IgG4-positive plasma cells (>100 per high-power field [hpf]). The adjacent noncarcinomatous areas, submandibular gland, and regional lymph nodes also contained plasma cells immunoreactive to IgG4 with densities higher than 100/hpf. To the best of our knowledge, this case is the first documentation of malignancy occurring in a background of IgG4-related autoimmune disease of the salivary gland.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Autoimmune Diseases / complications
  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / pathology*
  • Humans
  • Immunoglobulin G / blood*
  • Lymphatic Metastasis / pathology
  • Male
  • Parotid Gland / pathology*
  • Salivary Gland Neoplasms / blood
  • Salivary Gland Neoplasms / etiology
  • Salivary Gland Neoplasms / pathology*
  • Sclerosis
  • Sialadenitis / blood
  • Sialadenitis / complications
  • Sialadenitis / immunology
  • Sialadenitis / pathology*

Substances

  • Immunoglobulin G