Wick Mark R, O'Malley Dennis P
Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, MRW, Charlottesville, VA, United States; Clarient Pathology Services, Aliso Viejo, CA, United States; M.D. Anderson Cancer Center, DPO, Houston, TX, United States.
Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, MRW, Charlottesville, VA, United States; Clarient Pathology Services, Aliso Viejo, CA, United States; M.D. Anderson Cancer Center, DPO, Houston, TX, United States.
Semin Diagn Pathol. 2018 Jan;35(1):61-66. doi: 10.1053/j.semdp.2017.11.006. Epub 2017 Nov 11.
IgG4-related sclerosing disease, which now encompasses diverse organ-related disorders with various prior eponymic designations, may also present with solitary or multifocal lymph node enlargement. This review considers the histopathologic features of IgG4 lymphadenopathy (IgG4LAD), which has been subdivided by Cheuk & Chan into 5 microscopic subtypes. Those include variants that are typified by multicentric Castleman disease (MCD)-like changes, follicular hyperplasia, interfollicular lymphoplasmacytic proliferation, progressive transformation of germinal centers, and formation of inflammatory pseudotumor (IPT)-like lesions. All of them demonstrate an excess of IgG4-immunoreactive plasma cells in the inflammatory cell population. Differential diagnostic considerations for IgG4LAD include true MCD, true IPT, luetic lymphadenitis, Rosai-Dorfman disease, and inflammatory myofibroblastic tumor, among others. An interpretative distinction between malignant lymphoma and IgG4LAD is also crucial.
IgG4相关硬化性疾病现在涵盖了多种具有不同既往命名的器官相关疾病，也可能表现为孤立性或多灶性淋巴结肿大。本文综述了IgG4淋巴结病（IgG4LAD）的组织病理学特征，Cheuk和Chan已将其细分为5种微观亚型。这些亚型包括以多中心Castleman病（MCD）样改变、滤泡增生、滤泡间淋巴浆细胞增殖、生发中心进行性转化以及炎性假瘤（IPT）样病变为特征的变体。所有这些都在炎症细胞群中显示出过量的IgG4免疫反应性浆细胞。IgG4LAD的鉴别诊断考虑因素包括真性MCD、真性IPT、梅毒淋巴结炎、Rosai-Dorfman病和炎性肌成纤维细胞瘤等。区分恶性淋巴瘤和IgG4LAD也至关重要。
