Lymphadenopathy of IgG4-related sclerosing disease: three case reports and review of literature

Int J Hematol. 2010 Dec;92(5):751-6. doi: 10.1007/s12185-010-0721-7. Epub 2010 Dec 1.

Abstract

Immunoglobulin (Ig) G4-related sclerosing disease is a recently described syndrome characterized by lymphoplasmacytic infiltration of exocrine glands or extranodal tissues and elevated serum IgG4. We report three cases of lymphadenopathy secondary to IgG4-related sclerosing disease. Histologic features of involved lymph nodes included interfollicular immunoblasts and plasma cells, similar to Castleman's disease. The percentage of IgG4-/IgG-positive plasma cells in the three patients was markedly elevated (30, 50, and 60%). Administration of prednisolone led to remission in every case. One of three cases was consulted to our hospital due to suspected diagnosis of angioimmunoblastic T cell lymphoma (AITL). The case demonstrates many clinical and pathologic similarities between IgG4-related sclerosing disease and AITL. Pathological similarities between AITL and the lymphoplasmacytic subtype of IgG4-sclerosing disease have recently been reported. It is important to accurately diagnose IgG4-related lymphadenopathy given its ready response to steroid therapy and the potential for misdiagnosing lymphoma on clinical grounds.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunoglobulin G / blood*
  • Immunoglobulin G / immunology
  • Lymphatic Diseases / pathology*
  • Lymphoid Tissue / pathology
  • Lymphoma, T-Cell / pathology
  • Male
  • Plasma Cells / cytology
  • Prednisone / therapeutic use
  • Sclerosis / drug therapy
  • Sclerosis / pathology*
  • Treatment Outcome

Substances

  • Glucocorticoids
  • Immunoglobulin G
  • Prednisone