Immunoglobulin G4-related lymphadenopathy with inflammatory pseudotumor-like features

Abstract

Immunoglobulin (Ig) G4-related disease has been recently described. This disease affects various organs, including lymph nodes. We describe the case of a 52-year-old Japanese man with IgG4-related lymphadenopathy with inflammatory pseudotumor (IPT)-like features. Five years ago, the patient noticed a painless mass in the mandible but did not consult a doctor. Recently, he noted that the mass had increased in size and consulted an oral surgeon in the hospital. Excisional biopsy was performed for diagnosis. Histopathological examination revealed that most of the enlarged lymph node was occupied by the hyalinized tissue. A few residual lymphoid follicles with hyperplastic germinal centers and infiltration of plasma cells and eosinophils were observed. Most of the plasma cells expressed IgG4, and the ratio of IgG4-positive cells to IgG-positive cells was 57.1%. These findings were consistent with IgG4-related lymphadenopathy. In conclusion, pathologists should consider IgG4-related lymphadenopathy when diagnosing a lesion with IPT-like features.

Systemic IgG4-related disease with extensive peripheral nerve involvement that progressed from localized IgG4-related lymphadenopathy: an autopsy case

“…In this patient, the submandibular lymph node that was excised 3 years previously was eventually proven to be PTGC-type IgG4-related lymphadenopathy, whereas some of the mediastinal and peri-choledochal lymph nodes showed an IPT-like feature with obliterative phlebitis [1-4,9]. Thus, 2 different types of IgG4-related lymphadenopathy were confirmed in 1 person over time.…”

Rheumatoid Lymphadenopathy with Abundant IgG4+ Plasma Cells : A Case Mimicking IgG4-Related Disease

“…[4][5][6][7][8][9] IgG4-related disease sometimes involves regional and/or systemic lymph nodes, and there is a variety of five different histological subtypes. 5,8,13 RA is characterized by high serum IL-6 level, 8,10,14,15 and showed elevation of CRP level, polyclonal hyper-gglobulinemia, anemia, hypoalbuminemia, and hypocholesterolemia. These symptoms are closely related to high IL-6 levels ; therefore, RA is considered as a hyper-IL-6 syndrome, 8,9,14 and IL-6 acts to elevate the serum levels of IgG4 and other IgG subclasses.…”

IgG4-Related Lymphadenopathy

“…In this type, the lymph nodes show asymptomatic localized lymphadenopathy [13]. Histologically, most of the lymph node is occupied by hyalinized fibrous tissue.…”

“…Small lymphocytes, plasma cells, and eosinophils infiltrate the dense sclerotic tissue (Figure 5). This type is rare; we have encountered only 2 cases, and no other cases have been reported thus far [1, 13]. …”

“…Nodal IPT has been histologically classified into 3 stages (i.e., Stage I, II, and III) [14, 15]. IPT-like IgG4-related lymphadenopathy is similar to lymphadenopathy in patients with stage III nodal IPT [1, 13]. However, IPT-like IgG4-related lymphadenopathy and nodal IPT are clinically different, because patients with nodal IPT usually show symptoms that are suggestive of lymphoid malignancy (e.g., fever, fatigue, weight loss, and night sweats) [14, 15].…”