Histopathological findings in 29 lymph node biopsies with increased IgG4 plasma cells

• Published in: Modern pathology Vol. 25; no. 3; pp. 480 - 491
• Main Authors: Grimm, Kate E, Barry, Todd S, Chizhevsky, Vladislav, Hii, Anselm, Weiss, Lawrence M, Siddiqi, Imran N, Brynes, Russell K, O'Malley, Dennis P
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.03.2012; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Antigens; Autoimmune Diseases - immunology; Autoimmune Diseases - pathology; Biomarkers - metabolism; Biopsy; Disease; Female; Flow Cytometry; Germinal Center - pathology; Humans; Hyperplasia; Immunoglobulin G - blood; Immunophenotyping; Laboratory Medicine; Lymph Nodes - pathology; Lymphatic Diseases - blood; Lymphatic Diseases - pathology; Lymphatic system; Male; Medicine; Medicine & Public Health; Middle Aged; original-article; Pancreatitis; Pathology; Plasma; Plasma Cells - immunology; Plasma Cells - pathology; Sclerosis - immunology; Sclerosis - pathology; Stains & staining; Young Adult; Los Angeles California; United States > US; IgG4; IgG4-related sclerosing disease; lymph node; reactive lymphadenopathy
• ISSN: 0893-3952; 1530-0285
• DOI: 10.1038/modpathol.2011.177

IgG4-related sclerosing disease encompasses a family of disorders associated with increased numbers of IgG4 plasma cells and mass forming lesions in various tissues. Lymphadenopathy is a common finding, seen in up to 80% of cases. In the largest series of cases to date, we describe histologic, immunohistochemical, special stain and flow cytometric findings in 29 cases of enlarged lymph nodes with increased IgG4 plasma cells. Lymph node biopsies showed all resection specimens; no needle core biopsies of tissue were evaluated. Cases were considered to have increased numbers of IgG4 plasma cells using the histological criteria outlined by Cheuk and Chan (2010): IgG4 plasma cells >50 cells in a high-power field and >40% of IgG-positive plasma cells positive for IgG4. Additionally, increased intrafollicular plasma cells were a common finding. The lymph nodes showed a variety of reactive histological features including follicular hyperplasia, progressive transformation of germinal centers, interfollicular expansions, variable degrees of fibrosis, increased histiocytes and occasionally an appearance similar to that of plasma cell Castleman disease.