IgG4-Related Disease: A Reminder for Practicing Pathologists

Arch Pathol Lab Med. 2017 Nov;141(11):1476-1483. doi: 10.5858/arpa.2017-0257-RA.

Abstract

IgG4-related disease (IgG4-RD) is a systemic autoimmune fibroinflammatory disease that produces sclerotic, tumefactive masses containing dense lymphoplasmacytic infiltrates rich in immunoglobulin (Ig) G4+ plasma cells. Initially characterized as a form of autoimmune pancreatitis, the distinctive histopathology of IgG4-RD has now been described in almost every organ system. However, because the clinical manifestations of IgG4-RD are diverse and nonspecific, the disease may go unsuspected until a biopsy or resection specimen is obtained to diagnose a presumed malignancy. Pathologists thus play a key role in the diagnosis of IgG4-RD, and familiarity with its histopathologic features is essential to preventing the irreversible comorbidities associated with this treatable disease. This brief review outlines the epidemiology, clinical manifestations, and histopathology of IgG4-RD, with the aim of furthering pathologists' awareness of and ability to diagnose this disorder.

Publication types

  • Review

MeSH terms

  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / metabolism
  • Autoimmune Diseases / pathology
  • Autoimmune Diseases / therapy
  • Autoimmune Hypophysitis / diagnosis
  • Autoimmune Hypophysitis / metabolism
  • Autoimmune Hypophysitis / pathology
  • Diagnosis, Differential
  • Fibrosis
  • Humans
  • Immunoglobulin G / metabolism*
  • Lymphocytes, Tumor-Infiltrating / immunology
  • Lymphocytes, Tumor-Infiltrating / metabolism
  • Lymphocytes, Tumor-Infiltrating / pathology*
  • Plasma Cells / immunology
  • Plasma Cells / metabolism
  • Plasma Cells / pathology*

Substances

  • Immunoglobulin G