Perifollicular granulomatous inflammation in reactive lymph nodes: a possible morphologic marker for IgG4 plasmacytosis

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• 作者：Imran N. Siddiqi (1)
  Russell K. Brynes (1)
  Kate Grimm (2)
  Dennis P. O’Malley (2)
  Endi Wang (3)
  
• 关键词：IgG4 plasmacytosis ; Plasma cell ; Lymphadenopathy ; Mikulicz’s disease ; Antinuclear antibodies
• 刊名：Journal of Hematopathology
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：4
• 期：4
• 页码：207-214
• 全文大小：871KB
• 参考文献：1. Sato Y, Notohara K, Kojima M, Takata K, Masaki Y, Yoshino T (2010) IgG4-related disease: historical overview and pathology of hematological disorders. Pathol Int 60(4):247-58 CrossRef
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  12. Grimm K, Barry TS, Chizhevsky V, Hii A, Weiss LM, Siddiqi I, Brynes RK, O’Malley DP (2011) Histopathologic findings in 29 lymph node biopsies with increased IgG4 plasma cells. Mod Pathol (in press)
  
• 作者单位：Imran N. Siddiqi (1)
  Russell K. Brynes (1)
  Kate Grimm (2)
  Dennis P. O’Malley (2)
  Endi Wang (3)
  
  1. Department of Pathology, University of Southern California Keck School of Medicine, 2011 Zonal Ave., HMR 209, Los Angeles, CA, 90033, USA
  2. Clarient Inc./GE Healthcare, Aliso Viejo, CA, USA
  3. Department of Pathology, Duke University Medical Center, Durham, NC, USA
  

文摘

IgG4-related sclerosing disease is a steroid-responsive syndrome of possible autoimmune origin that can manifest with mass-like lesions in a variety of organ sites. Lymph node involvement may clinically mimic malignant lymphoma, Castleman disease, or infectious lymphadenitis; consequently, accurate diagnosis is necessary to exclude other processes and to initiate steroid therapy appropriately. Histologically, a number of relatively nonspecific features have been associated with IgG4-related lymphadenopathy, mainly increased plasma cells in an interfollicular or intra-germinal center pattern. We describe seven lymph node cases with distinctive perifollicular granulomas, in a concentric or crescent-like arrangement, partially or completely encircling lymphoid follicles. This finding was specifically associated with a marked intra-germinal center increase in IgG4-positive plasma cells, as compared to other patterns of nodal granulomas in a series of control cases. We discuss the clinicopathologic features of these cases, including an unusual presentation in a pediatric patient. This study adds to the morphologic spectrum of IgG4-related lymphadenopathy.