IgG4-related disease involving the esophagus: a clinicopathological study

被引:26
|
作者
Obiorah, I. [1 ]
Hussain, A. [2 ]
Palese, C. [2 ]
Azumi, N. [1 ]
Benjamin, S. [2 ]
Ozdemirli, M. [1 ]
机构
[1] Medstar Georgetown Univ Hosp, Dept Pathol, 3800 Reservoir Rd NW, Washington, DC 20007 USA
[2] Medstar Georgetown Univ Hosp, Dept Internal Med, Div Gastroenterol, Washington, DC USA
关键词
autoimmune; endoscopy; esophagus; gG4; immunohistochemistry; EOSINOPHILIC ESOPHAGITIS; IGG4; RITUXIMAB;
D O I
10.1093/dote/dox091
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Immunoglobulin G4 (IgG4)-related disease is a recently coined systemic disease characterized by specific histopathologic findings of an intense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis in the presence of predominant IgG4-positive plasma cells. Although IgG4-related disease has been described in many organs, involvement of the esophagus is very rare. In this study, we describe the clinicopathologic characteristics of eight patients with IgG4-related esophagitis. We evaluated chronic esophagitis specimens with lymphoplasmacytic infiltrate obtained over the past 6 years (from January 2011 to February 2017) using a chart review, pathologic examination, and IgG4 immunohistochemical staining. The diagnoses of the specimens were either confirmed as IgG4-related esophagitis (IgG4-RE) or chronic esophagitis, not otherwise specified (CENOS), and the clinicopathologic data from each group were compared. Eight patients were diagnosed with IgG4-RE and 10 controls were identified and diagnosed with CENOS. In the IgG4-RE group, esophageal strictures were identified in three patients, two patients had postmyotomy treated achalasia, one patient had erosive esophagitis and another presented with an esophageal nodule. Only one patient had an unremarkable mucosa on endoscopy. In the CENOS group, four patients had esophageal strictures, six had erosive esophagitis, one patient had mild esophagitis. The IgG4-RE group had significantly higher numbers of IgG4-positive plasma cells (66.9 +/- 21.9 vs. 4.7 +/- 2.4 per high power field; P < 0.001) and a greater IgG4: IgG ratio 0.76 +/- 0.13 vs. 0.06 +/- 0.05; P < 0.001) when compared to CENOS patients. Two of the patients with recurrent esophageal strictures in the IgG4-RE group showed initial response to steroid therapy and are currently on immunosuppressive therapy which has significantly reduced the need for multiple esophageal dilatations. The presentation of IgG4-related esophageal disease can vary and the key to diagnosis is dependent on histopathology. These observations highlight the need for IgG4 immunohistochemical staining of esophageal biopsies especially in patients with mucosal ulceration, chronic inflammation, and plasmacytosis on biopsy. This will prevent unwarranted esophagectomies and failed medical treatment due to lack of recognition of this entity.
引用
收藏
页数:7
相关论文
共 50 条
  • [1] The eosinophilic esophagitis and IgG4-related disease involving the esophagus
    Bakulina, N., V
    Simanenkov, V., I
    Vorobyev, S. L.
    Tikhonov, S., V
    Lishchuk, N. B.
    Bakulin, I. G.
    TERAPEVTICHESKII ARKHIV, 2020, 92 (08) : 100 - 107
  • [2] A clinicopathological study on IgG4-related ophthalmic disease
    Yuka Suimon
    Satoru Kase
    Kan Ishijima
    Hiromi Kanno-Okada
    Susumu Ishida
    International Journal of Ophthalmology, 2018, (09) : 1539 - 1544
  • [3] A clinicopathological study on IgG4-related ophthalmic disease
    Suimon, Yuka
    Kase, Satoru
    Ishijima, Kan
    Kanno-Okada, Hiromi
    Ishida, Susumu
    INTERNATIONAL JOURNAL OF OPHTHALMOLOGY, 2018, 11 (09) : 1539 - 1544
  • [4] IgG4-related disease involving the sclera
    Ohno, Kyotaro
    Sato, Yasuharu
    Ohshima, Koh-ichi
    Takata, Katsuyoshi
    Ando, Midori
    Abd Al-Kader, Lamia
    Iwaki, Noriko
    Takeuchi, Mai
    Orita, Yorihisa
    Yoshino, Tadashi
    MODERN RHEUMATOLOGY, 2014, 24 (01) : 195 - 198
  • [5] Oral and maxillofacial manifestations of IgG4-related disease: A clinicopathological study
    Pereira, Glauce Guimaraes
    Correa Pontes, Flavia Sirotheau
    Soares, Ciro Dantas
    Freire de Carvalho, Maria Goretti
    da Silva, Tarcilia Aparecida
    Calderaro, Debora Cerqueira
    Ferreira, Gilda Aparecida
    Tanure, Leandro Augusto
    de Souza, Lucas Lacerda
    Rodrigues-Fernandes, Carla Isabelly
    de Almeida, Oslei Paes
    Fonseca, Felipe Paiva
    Rebelo Pontes, Helder Antonio
    JOURNAL OF ORAL PATHOLOGY & MEDICINE, 2022, 51 (05) : 493 - 500
  • [6] IgG4-related ophthalmic disease: A clinicopathological study of 40 cases
    Ueda, Shunichiro
    Goto, Hiroshi
    Usui, Yoshihiko
    Kimura, Keisuke
    Umazume, Kazuhiko
    Matsubayashi, Jun
    Nagao, Toshitaka
    INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, 2014, 55 (13)
  • [7] Clinicopathological features of IgG4-related kidney disease
    Zhang, Ping
    Yin, Qing
    Wang, Wei
    Yao, Qi
    Zou, Yurong
    Li, Guisen
    Wang, Junru
    CLINICAL NEPHROLOGY, 2020, 94 (03) : 135 - 141
  • [8] Clinicopathological characteristics of IgG4-related lung disease
    Liu, Jia
    Liu, Yuxiang
    Shen, Ximing
    He, Zhanghai
    Yu, Tingfeng
    Pang, Li
    Jin, Xiaoyan
    Wang, Lingyun
    BMC PULMONARY MEDICINE, 2021, 21 (01)
  • [9] Clinicopathological characteristics of IgG4-related lung disease
    Jia Liu
    Yuxiang Liu
    Ximing Shen
    Zhanghai He
    Tingfeng Yu
    Li Pang
    Xiaoyan Jin
    Lingyun Wang
    BMC Pulmonary Medicine, 21
  • [10] Investigations of IgG4-related disease involving the skin
    Yamada, Kazunori
    Hamaguchi, Yasuhito
    Saeki, Takako
    Yagi, Kunimasa
    Ito, Naoko
    Kakuchi, Yasushi
    Yamagishi, Masakazu
    Takehara, Kazuhiko
    Nakanuma, Yasuni
    Kawano, Mitsuhiro
    MODERN RHEUMATOLOGY, 2013, 23 (05) : 986 - 993