Zukerberg Lawrence, Mahadevan Krishnan, Selig Martin, Deshpande Vikram
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Histopathology. 2016 Jun;68(7):968-76. doi: 10.1111/his.12892. Epub 2016 Jan 21.
To explore the utility of an IgG4 immunohistochemical stain to help distinguish eosinophilic oesophagitis from gastroesophageal reflux disease.
We examined 21 cases of eosinophilic oesophagitis and 25 cases of gastroesophageal reflux disease. The diagnosis of eosinophilic oesophagitis was based on the presence of oesophageal dysfunction, >15 eosinophils per high-power field, and a lack of response to proton pump inhibitors. Gastroesophageal reflux disease showed intraepithelial eosinophils, but a clinical and/or histological response to proton pump inhibitor therapy. We also evaluated an additional cohort of 22 cases with intraepithelial eosinophils. Immunohistochemical staining for IgG4 was performed. Sixteen of 21 (76%) eosinophilic oesophagitis cases showed intrasquamous extracellular IgG4 deposits, whereas all 25 gastroesophageal reflux disease cases were negative. Mucosal IgG4-positive plasma cells were identified in eosinophilic oesophagitis and gastroesophageal reflux disease cases in 58% and 40% of cases, respectively. Eosinophilic oesophagitis patients receiving treatment were less likely to be positive for intraepithelial IgG4 deposits (88% versus 53%). In the validation cohort, the sensitivity and specificity for eosinophilic oesophagitis were 88% and 100%, respectively.
The presence of intrasquamous IgG4 deposits is a useful adjunctive marker in the distinction between eosinophilic oesophagitis and gastroesophageal reflux disease.
探讨IgG4免疫组化染色在鉴别嗜酸性粒细胞性食管炎与胃食管反流病中的作用。
我们检查了21例嗜酸性粒细胞性食管炎患者和25例胃食管反流病患者。嗜酸性粒细胞性食管炎的诊断依据为存在食管功能障碍、每高倍视野嗜酸性粒细胞>15个以及对质子泵抑制剂无反应。胃食管反流病表现为上皮内嗜酸性粒细胞，但对质子泵抑制剂治疗有临床和/或组织学反应。我们还评估了另外一组22例上皮内嗜酸性粒细胞患者。进行了IgG4免疫组化染色。21例嗜酸性粒细胞性食管炎患者中有16例（76%）显示鳞状上皮内细胞外IgG4沉积，而所有25例胃食管反流病患者均为阴性。在嗜酸性粒细胞性食管炎和胃食管反流病患者中，分别有58%和40%的病例发现黏膜IgG4阳性浆细胞。接受治疗的嗜酸性粒细胞性食管炎患者上皮内IgG4沉积阳性的可能性较小（88%对53%）。在验证队列中，嗜酸性粒细胞性食管炎的敏感性和特异性分别为88%和100%。
鳞状上皮内IgG4沉积的存在是鉴别嗜酸性粒细胞性食管炎和胃食管反流病的有用辅助标志物。
