Uehara Takeshi, Hamano Hideaki, Suga Tomoaki, Kawa Shigeyuki, Yoshizawa Akihiko, Kobayashi Yukihiro, Murata Kazuya, Oki Keiko, Sano Kenji, Onodera Rie, Ota Hiroyoshi
Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Pathol Int. 2014 Feb;64(2):67-74. doi: 10.1111/pin.12139.
Although immunoglobulin G4-related diseases (IgG4-RD) have been found to affect many organs, little is known about their effects on the colonic mucosae. Pathological examination of colon adenomas has shown inflammatory cell infiltration into the stroma. We therefore assessed the clinicopathological characteristics of colon adenomas in patients with type 1 autoimmune pancreatitis (AIP-1), a representative IgG4-RD. Both colon adenomas from patients with (IgG4 adenomas) and without (Non-IgG4 adenomas) IgG4-RD were characterized by moderate to severe lymphoplasmacytic and eosinophilic inflammation without fibrosis or phlebitis. The ratio of IgG4-positive to IgG-positive plasma cells (IgG4/IgG ratio) and the numbers of IgG4-positive plasma cells were significantly higher in IgG4 adenomas than in Non-IgG4 adenomas. IgG4-positive plasma cells tended to be distributed diffusely in lower areas of the mucosae in IgG4 adenomas. We were unable to confirm whether IgG4 adenomas constituted an IgG4-RD. However, IgG4 adenomas in the setting of IgG4-RD may provide useful pathological information, supplementing a diagnosis of IgG4-RD outside the colon, or may facilitate examination for IgG4-RD, especially AIP-1. IgG4 adenomas warrant further investigation.
尽管免疫球蛋白G4相关疾病（IgG4-RD）已被发现可累及多个器官，但对其对结肠黏膜的影响却知之甚少。结肠腺瘤的病理检查显示基质中有炎性细胞浸润。因此，我们评估了1型自身免疫性胰腺炎（AIP-1，一种典型的IgG4-RD）患者结肠腺瘤的临床病理特征。患有IgG4-RD（IgG4腺瘤）和未患IgG4-RD（非IgG4腺瘤）患者的结肠腺瘤均表现为中度至重度淋巴细胞浆细胞和嗜酸性粒细胞炎症，无纤维化或静脉炎。IgG4腺瘤中IgG4阳性浆细胞与IgG阳性浆细胞的比例（IgG4/IgG比例）以及IgG4阳性浆细胞数量均显著高于非IgG4腺瘤。在IgG4腺瘤中，IgG4阳性浆细胞倾向于在黏膜下层弥漫分布。我们无法确定IgG4腺瘤是否构成IgG4-RD。然而，IgG4-RD背景下的IgG4腺瘤可能提供有用的病理信息，辅助结肠外IgG4-RD的诊断，或有助于IgG4-RD的检查，尤其是AIP-1。IgG4腺瘤值得进一步研究。
