Most IgG4-related sclerosing diseases have been found to be associated with AIP, but IgG4-related sclerosing diseases without pancreatic involvement have been reported
Most IgG4-related sclerosing diseases have been found to be associated with AIP, but IgG4-related sclerosing diseases without pancreatic involvement have been reported. rather specific to AIP patients. We propose a new clinicopathological entity, IgG4-related sclerosing disease and suggest that AIP is a pancreatic lesion reflecting this systemic disease. = 6; and sclerosing sialadenitis, = 1) and cervical lymph nodes (AIP, = 2; and sclerosing sialadenitis, = 3) (Fig. ?(Fig.3c).3c). However, only a few IgG4-positive plasma cells were seen to infiltrate abdominal lymph nodes of patients with chronic alcoholic pancreatitis or pancreatic cancer, or cervical lymph nodes of patients with Boc-NH-C6-amido-C4-acid Sj?grens syndrome.8 Sclerosing cholecystitis In our series, thickening of the gallbladder was detected on US or CT in 11 of 32 (34%) patients with AIP. Dense infiltration of IgG4-positive plasma cells and lymphocytes, as well as transmural fibrosis, was detected in the gallbladder wall of six of eight examined patients.105 Interstitial pneumonia A 63-year-old man had concurrent interstitial pneumonia and AIP, both of Boc-NH-C6-amido-C4-acid which improved after steroid therapy. Transbronchial lung biopsy showed dense infiltration of IgG4-positive plasma cells in the alveolar septum.106 Recently, Hirano et al.107 reported that 4 (four men; average age, 69.5 years) of 30 patients with AIP had pulmonary involvement, and they showed good response Boc-NH-C6-amido-C4-acid to steroid therapy. Tubulointerstitial nephritis Two cases (in a 64-year-old man108 and a 66-year-old man109) of tubulointerstitial nephritis associated with AIP have been reported. Both diseases improved after steroid therapy. The renal biopsy done in one case showed IgG4-positive staining along the tubular basement membrane and infiltration of IgG4-positive plasma cells into the tubulointerstitium. Hepatic inflammatory pseudotumor Hepatic inflammatory pseudotumor is a rare benign lesion characterized by polyclonal lymphoplasmacytic infiltration with fibrosis and is sometimes misdiagnosed as primary hepatic malignant tumor. In two reported cases (a 48-year-old man65 and a 79-year-old man110) of hepatic inflammatory pseudotumor associated with AIP, the tumor showed dense infiltration of IgG4-positive plasma cells, fibrosis, and obliterative phlebitis. Both the hepatic inflammatory pseudotumor and AIP improved after steroid therapy. Zen et al.12 found extensive and dense fibrosis with dense infiltration of IgG4-positive plasma cells and lymphocytes, and obliterative phlebitis was seen in Boc-NH-C6-amido-C4-acid the bile duct Boc-NH-C6-amido-C4-acid lesions of five patients (five men; average age, 65.0 years) with a hepatic inflammatory pseudotumor associated with sclerosing cholangitis. This suggests that these conditions could be included in a common disease entity. Inflammatory pseudotumor of the lung We treated a 63-year-old man who had a concurrent inflammatory pseudotumor of the lung and AIP, both of which improved after steroid therapy. The resected lung tumor showed dense infiltration of IgG4-positive plasma cells and lymphocytes intermixed with fibrosis and obliterative phlebitis. Zen et al.13 reported nine cases (five men, four women; average age, 56.8 years) with an inflammatory pseudotumor NMYC of the lung that had the same pathological findings as those mentioned above; no cases were associated with AIP, and two cases were associated with sclerosing sialadenitis or lymphadenopathy. Other reported lesions associated with AIP are pseudotumor of the hypophysis,111 immune thrombocytopenic purpura,112,113 autoimmune sensorineural hearing loss,113 hypothyroidism,114 anosmia,115 and loss of taste.115 IgG4-related sclerosing disease By histologically and immunohistochemically examining various organs of AIP patients, dense infiltration of IgG4-positive plasma cells as well as CD4- or CD8-positive T lymphocytes and fibrosis have been observed in the peripancreatic retroperitoneal tissue, bile duct wall, gallbladder wall, periportal area of the liver, salivary glands, as well as the pancreas of AIP patients.7,8,32 All extrapancreatic lesions associated with AIP such as sclerosing cholangitis, sclerosing sialadenitis, or retroperitoneal fibrosis show infiltration of abundant IgG4-positive plasma cells, but the infiltration is not detected in those of PSC, Sj?grens syndrome, sialolithiasis, chronic alcoholic pancreatitis, or pancreatic cancer. Both pancreatic and extrapancreatic lesions of AIP respond well to steroid therapy, being different from PSC. We therefore propose the existence of a novel clinicopathological entity, an IgG4-related sclerosing disease incorporating sclerosing pancreatitis, cholangitis, sialadenitis, and retroperitoneal fibrosis with lymphadenopathy. It is histopathologically characterized by extensive IgG4-positive plasma cell and T-lymphocyte infiltration of various organs. Major clinical manifestations are apparent in the pancreas, bile duct, salivary glands, and retroperitoneum, in which tissues fibrosis with obliterative phlebitis is pathologically induced. AIP is not simply.