Rollins-Raval Marian A, Felgar Raymond E, Krasinskas Alyssa M, Roth Christine G
Department of Pathology, University of Pittsburgh School of Medicine, 200 Lothrop Street-Suite G300, Pittsburgh, PA 15213, USA.
Int J Surg Pathol. 2012 Feb;20(1):47-53. doi: 10.1177/1066896911420562. Epub 2011 Sep 12.
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.
IgG4 相关硬化性疾病（IRSD）是一种对类固醇有反应的纤维炎性疾病，其特征为 IgG4+细胞增多。淋巴结受累通常缺乏在结外部位所见的致密硬化，组织学模式与其他反应性过程重叠。通过免疫组织化学对 26 个显示 IRSD 相关组织学模式的淋巴结进行 IgG 和 IgG4 阳性细胞评估，并与临床特征相关联。病例包括 7 例 Castleman 病样病例（I 型模式）、10 例滤泡增生（II 型）和 9 例浆细胞增多症（III 型）。每个高倍视野（HPF）中 IgG4+细胞的平均数量分别为 4.8（I 型）、8.4（II 型）和 26.6（III 型），IgG4/IgG 平均比值分别为 0.05（I 型）、0.04（II 型）和 0.08（III 型）。对于绝对和相对增加，使用>50 个 IgG4+细胞/HPF 和 IgG4/IgG 比值>0.4 的标准，只有 1 例同时满足 IgG4+细胞增加的两个标准，该患者患有桥本甲状腺炎，但无 IRSD 的临床证据。结果表明，在非 IRSD 淋巴结中很少见到 IgG4+细胞增加。
