Increased numbers of IgG4-positive plasma cells may rarely be seen in lymph nodes of patients without IgG4-related sclerosing disease

Int J Surg Pathol. 2012 Feb;20(1):47-53. doi: 10.1177/1066896911420562. Epub 2011 Sep 12.

Abstract

IgG4-related sclerosing disease (IRSD) is a steroid-responsive fibroinflammatory disorder characterized by increased IgG4+ cells. Nodal involvement usually lacks the dense sclerosis seen in extranodal sites, with histologic patterns overlapping with other reactive processes. Twenty-six lymph nodes showing IRSD-related histologic patterns were evaluated for IgG and IgG4 positive cells by immunohistochemistry and correlated with the clinical features. Cases included 7 Castleman disease-like cases (type I pattern), 10 follicular hyperplasia (type II), and 9 plasmacytosis (type III). The mean numbers of IgG4+ cells per high-power field (HPF) were 4.8 (I), 8.4 (II), and 26.6(III), and the mean IgG4/IgG ratios were 0.05 (I), 0.04 (II), and 0.08 (III). Using >50 IgG4+cells/HPF and IgG4/IgG ratio of >0.4 for absolute and relative increases, only 1 case fulfilled both criteria for increased IgG4+ cells, a patient with Hashimoto's thyroiditis without clinical evidence of IRSD. The results suggest that increased IgG4+ cells may rarely be seen in non-IRSD lymph nodes.

MeSH terms

  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / pathology
  • Humans
  • Immunoglobulin G / immunology*
  • Immunohistochemistry
  • Lymph Nodes / immunology
  • Lymph Nodes / pathology*
  • Lymphatic Diseases / immunology
  • Lymphatic Diseases / pathology*
  • Plasma Cells / immunology
  • Plasma Cells / pathology*
  • Sclerosis / immunology

Substances

  • Immunoglobulin G