Stan Marius N, Sonawane Vikram, Sebo Thomas J, Thapa Prabin, Bahn Rebecca S
Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Clin Endocrinol (Oxf). 2017 Mar;86(3):425-430. doi: 10.1111/cen.13238. Epub 2016 Oct 7.
IgG4-positive (+) plasma cells have been reported in both Riedel's thyroiditis (RT) and Hashimoto's thyroiditis (HT). These cells are the hallmark of IgG4-related disease (IgG4-RD).
We sought to determine whether RT is part of IgG4-RD spectrum.
DESIGN, SETTING AND PATIENTS: This was a case-control study performed at a tertiary medical centre. We included RT cases from the period 1958 to 2008 that had sufficient paraffin-embedded tissue for IgG4 immunostaining. Controls were patients with HT, age and gender matched, with similar pathology criteria.
The main outcome measures were the intensity of the IgG4 staining and the clinical and histological correlates with IgG4-RD.
Six pairs of RT and HT were analysed. The mean age was 44·7 years. In both groups, 5/6 cases had positive IgG4 staining. The mean number of IgG4 + cells/ HPF, normalized to the degree of inflammation, was 3·2 ± 3·0 SD (RT) vs 0·9 ± 0·7 (HT), P = 0·15, for fibrotic areas and 2·1 ± 2·3 SD vs 1·0 ± 0·8 (P = 0·39) for areas with lymphoid aggregates. We found the number of IgG4 + cells in RT to be inversely correlated with the duration of disease (P = 0·046). Three RT cases had associated comorbidities from the IgG4-RD spectrum while none of the HT cases had such conditions.
Riedel's thyroiditis is a component of IgG4-RD with the density of the IgG4 + lymphocytic infiltrate being time dependent. In this small study, we did not identify differences in IgG4 infiltration between RT and HT, minimizing the utility of this marker in RT diagnosis.
在Riedel甲状腺炎（RT）和桥本甲状腺炎（HT）中均有IgG4阳性（+）浆细胞的报道。这些细胞是IgG4相关疾病（IgG4-RD）的标志。
我们试图确定RT是否属于IgG4-RD谱系的一部分。
设计、地点和患者：这是一项在三级医疗中心进行的病例对照研究。我们纳入了1958年至2008年间有足够石蜡包埋组织用于IgG4免疫染色的RT病例。对照组为年龄和性别匹配、病理标准相似的HT患者。
主要观察指标为IgG4染色强度以及与IgG4-RD相关的临床和组织学特征。
分析了6对RT和HT病例。平均年龄为44.7岁。两组中，5/6的病例IgG4染色呈阳性。对于纤维化区域，IgG4+细胞/HPF的平均数（根据炎症程度进行标准化）在RT组为3.2±3.0标准差，在HT组为0.9±0.7，P = 0.15；对于有淋巴滤泡聚集的区域，RT组为2.1±2.3标准差，HT组为1.0±0.8（P = 0.39）。我们发现RT中IgG4+细胞的数量与疾病持续时间呈负相关（P = 0.046）。3例RT病例伴有IgG4-RD谱系中的合并症，而HT病例均无此类情况。
Riedel甲状腺炎是IgG4-RD的一个组成部分，IgG4+淋巴细胞浸润密度与时间有关。在这项小型研究中，我们未发现RT和HT之间IgG4浸润存在差异，这使得该标志物在RT诊断中的实用性降低。
