Riedel's Thyroiditis and Multifocal Fibrosclerosis are part of the IgG4‐related systemic disease spectrum

Dahlgren, Mollie; Khosroshahi, Arezou; Nielsen, G. Petur; Deshpande, Vikram; Stone, John H.

doi:10.1002/acr.20215

Cited by 300 publications

(206 citation statements)

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“…27,30,31 As a result of the histological similarity, confusion has been noted in the literature regarding Riedel's thyroiditis and fibrous variant of Hashimoto's thyroiditis. 23 Most recently, an association between Riedel's thyroiditis and IgG4-related disease has been described by Dahlgren et al 32 They demonstrated excessive numbers of the IgG4-positive plasma cells in Riedel's thyroiditis samples. This observation would seem to further blur the distinction between the IgG4-related Hashimoto's thyroiditis and Riedel's thyroiditis.…”

Section: Discussionmentioning

confidence: 97%

Distinct histopathological features of Hashimoto's thyroiditis with respect to IgG4-related disease

Zhou

Ozaki

et al. 2012

Modern Pathology

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A form of Hashimoto's thyroiditis with lymphoplasmacytic sclerosing changes and increased numbers of IgG4-positive plasma cells has recently been reported in the literature. These histopathological features suggest that this subtype of Hashimoto's thyroiditis may be closely related to IgG4-related disease. Therefore, this unique form of IgG4-related Hashimoto's thyroiditis, which is referred to as IgG4 thyroiditis, has its own clinical, serological, and sonographic features that are distinct from those associated with non-IgG4 thyroiditis. IgG4 thyroiditis shares similarities with the well-known fibrous variant of Hashimoto's thyroiditis; however, the detailed histopathological features of IgG4 thyroiditis have not been well established. Based on immunostaining results, 105 patients with Hashimoto's thyroiditis were divided into an IgG4 thyroiditis group (n ¼ 28) and a non-IgG4 thyroiditis group (n ¼ 77). As in our previous reports, IgG4 thyroiditis was associated with a patient population of a younger age, a lower female-to-male ratio, rapid progression, higher levels of thyroid autoantibodies, subclinical hypothyroidism, and diffuse sonographic echogenicity. Histopathologically, this group revealed severe lymphoplasmacytic infiltration, dense stromal fibrosis, marked follicular cell degeneration, numerous micro-follicles, and notable giant cell/histiocyte infiltration. Importantly, the IgG4-related group did not completely overlap with fibrous variant of Hashimoto's thyroiditis. Four cases (14%) in the IgG4 thyroiditis group presented only mild fibrosis in the stroma, whereas 29 cases (38%) in the non-IgG4 thyroiditis group met the diagnostic criteria for fibrous variant of Hashimoto's thyroiditis. Furthermore, we observed three patterns of stromal fibrosis in Hashimoto's thyroiditis: interfollicular fibrosis, interlobular fibrosis, and scar fibrosis. The IgG4 thyroiditis group was significantly associated with the presence of predominant interfollicular fibrosis. In conclusion, IgG4 Hashimoto's thyroiditis presents histopathological features quite distinct from its non-IgG4 counterpart.

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Section: Discussionmentioning

confidence: 97%

Distinct histopathological features of Hashimoto's thyroiditis with respect to IgG4-related disease

Zhou

Ozaki

et al. 2012

Modern Pathology

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“…Disparate disorders such as Mikulicz's syndrome, Kü ttner's tumor, multifocal fibrosclerosis, and eosinophilic angiocentric fibrosis are now considered to fall within this disease spectrum. 7,[17][18][19] Although their presenting symptoms are highly variable, the features that tie these disease conditions together are a common histological appearance, elevated serum and tissue levels of IgG4, and a response, generally swift, to immunosuppression.…”

Section: Introduction and Historical Perspectivementioning

confidence: 99%

Consensus statement on the pathology of IgG4-related disease

et al. 2012

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IgG4-related disease is a newly recognized fibro-inflammatory condition characterized by several features: a tendency to form tumefactive lesions in multiple sites; a characteristic histopathological appearance; andoften but not always-elevated serum IgG4 concentrations. An international symposium on IgG4-related The histopathology of IgG4-related disease was a specific focus of the international symposium. The primary purpose of this statement is to provide practicing pathologists with a set of guidelines for the diagnosis of IgG4-related disease. The diagnosis of IgG4-related disease rests on the combined presence of the characteristic histopathological appearance and increased numbers of IgG4 þ plasma cells. The critical histopathological features are a dense lymphoplasmacytic infiltrate, a storiform pattern of fibrosis, and obliterative phlebitis. We propose a terminology scheme for the diagnosis of IgG4-related disease that is based primarily on the morphological appearance on biopsy. Tissue IgG4 counts and IgG4:IgG ratios are secondary in importance. The guidelines proposed in this statement do not supplant careful clinicopathological correlation and sound clinical judgment. As the spectrum of this disease continues to expand, we advocate the use of strict criteria for accepting newly proposed entities or sites as components of the IgG4-related disease spectrum.

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“…Many different terms have been used to describe conditions that have become more recently recognized as members of a spectrum of clinical involvement in IgG4-related systemic disease (31,(35)(36)(37)(38). Full recognition of the disease is challenging, as involvement of different organs affected is often metachronous.…”

Section: Discussionmentioning

confidence: 99%

A 45‐year‐old man with flank pain and inability to ejaculate

Muskardin

Gertner

2012

Arthritis Care & Research

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A 45-year-old man with left-sided flank pain and difficulty ejaculating. History of the Present IllnessThe patient developed left-sided flank pain in April 2010. He was evaluated in the emergency department when the pain had persisted for 3 weeks. He reported worsening of the pain in the evening and difficulty with ejaculation since the pain began: "I get a knot in my side," then "I can't ejaculate." He also reported associated low back pain and increased pain with bending to his left. His general physical examination was unremarkable. Urine analysis demonstrated 30 mg/dl protein, 10 mg/dl ketones, 8 mg/dl urobilinogen (reference value Ͻ2.0), 8 red blood cells/ high-power field (hpf), 2 white blood cells/hpf, and mucous. He was prescribed ibuprofen for abdominal pain and was advised to follow up with his primary care provider.The pain persisted. He saw his primary provider in July with worsening epigastric and left-sided abdominal and flank pain. By this time, he had decreased appetite, early satiety, and weight loss of 22 pounds. His primary provider ordered a computed tomographic (CT) scan of his abdomen and pelvis, which demonstrated a rind of soft tissue in the retroperitoneum surrounding the aorta and inferior vena cava and wall thickening of the sigmoid colon and rectum. A biopsy of the mass was done by interventional radiology at another hospital. Since his pain was unrelieved by acetaminophen/hydrocodone, he was admitted to our hospital for further evaluation and pain control. He did not know the results of the biopsy. Medical HistoryHe had been relatively healthy prior to the onset of illness in April. Atheromatous calcification of the aorta with mild ectasia inferiorly measuring up to 2.3 cm in diameter was noted incidentally on a CT scan obtained to evaluate for ureteral calculi in September 2008. He had a remote history of gonorrhea and chlamydia infections, which were treated. He had been seen in the emergency department for right testicular pain following trauma at age 35 years and left testicular pain without clear etiology at ages 40 and 43 years. The first episode of left testicular pain was attributed to epididymitis. The second was attributed to suspected passage of a ureteral calculus. Social and Family HistoryThe patient's family history was negative for rheumatic disorders. Several family members, including his mother, had diabetes mellitus and hypertension. His sister had thyroid disease. He was unemployed, but previously worked as a baker. He smoked one-quarter of a pack of cigarettes per day for several years, and previously smoked marijuana. He consumed, on average, 1 alcoholic beverage per week and denied intravenous drug use. He was sexually active and did not consistently use barrier protection. Review of SystemsThe patient reported persistent inability to ejaculate, without decrease in arousal or orgasm and without associated pain. He also reported low back pain that preceded his current illness by years. He had constipation for 2 weeks.

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Riedel's Thyroiditis and Multifocal Fibrosclerosis are part of the IgG4‐related systemic disease spectrum

Cited by 300 publications

References 33 publications

Distinct histopathological features of Hashimoto's thyroiditis with respect to IgG4-related disease

Distinct histopathological features of Hashimoto's thyroiditis with respect to IgG4-related disease

Consensus statement on the pathology of IgG4-related disease

A 45‐year‐old man with flank pain and inability to ejaculate

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