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Case of immunoglobulin G 4‐related skin disease: Possible immunoglobulin G 4‐related skin disease cases in cutaneous pseudolymphoma only by immunohistochemical analysis
Author(s) -
Iwata Yohei,
Mizoguchi Yoshikazu,
Takahashi Masayuki,
Tanaka Beni,
Kuroda Makoto,
Yagami Akiko,
Matsunaga Kayoko
Publication year - 2013
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/1346-8138.12301
Subject(s) - pseudolymphoma , pathology , medicine , immunostaining , histopathology , germinal center , immunohistochemistry , plasma cell , h&e stain , castleman disease , antibody , b cell , lymphoma , disease , immunology , bone marrow
Immunoglobulin G4‐related disease ( I g G 4‐ RD ) is a newly recognized disease characterized by elevated serum I g G 4 levels, tissue infiltration rich in I g G 4 + plasma cells. We report on a case which was first considered as pseudolymphoma from the histopathological analysis, but finally diagnosed as I g G 4‐related skin lesions. As the morphological features of cutaneous involvement of I g G 4‐ RD are consistent with those of cutaneous pseudolymphoma, we tried immunostaining past potential cases of I g G 4‐ RD . Thirty‐two skin specimens (15 men and 17 women; mean age, 53 years) diagnosed as having pseudolymphoma were retrieved from the archives to conduct hematoxylin–eosin, I g G and I g G 4 staining. Out of the 32 cases of cutaneous pseudolymphoma, germinal center formation was seen in 22 cases, and moderate–severe fibrosis was seen in seven cases. Eleven cases showed more than 10 I g G 4 + plasma cell infiltration/high‐power field, and among these 11 cases, seven cases (22%) showed A ratio of I g G 4 + / I g G + cells of more than 40%. Thus, out of the 32 cases of cutaneous pseudolymphomas, two cases (6.3%) satisfied I g G 4‐ RD histopathological diagnostic criteria. As clinical presentations and histopathological features of skin involvement of I g G 4‐ RD are analogous to cutaneous B‐cell pseudolymphoma, careful identification is required through systemic examination, serum I g G 4 measurement and other means.