Abstract
Plasma cell-type Castleman disease (PCD) is often encountered when differentiating IgG4-related disease (IgG4-RD). Given that serum IgA is often elevated in Castleman disease, we investigated whether IgA expression levels in histological specimens can be used to differentiate between the two diseases. Lymph node lesions obtained from 12 IgG4-RD and 11 PCD patients were analysed by immunohistochemistry with anti-IgG, -IgG4, and -IgA antibodies. In addition to all 12 cases of IgG4-RD, 8/11 cases (72.7 %) of PCD also met the diagnostic criteria of IgG4-RD (serum IgG4 ≥135 mg/dl and IgG4/IgG-positive cells ≥40 %). IgA-positive cells were sparsely and densely distributed in IgG4-RD and PCD cases, respectively. The median number of IgA-positive cells ± SD in all 12 cases of IgG4-RD was 31 ± 37 cells per three high-powered fields (3HPFs) (range 4–118 cells/3HPFs). In contrast, the median number of IgA-positive cells, which was significantly higher in all 11 cases of PCD, was 303 ± 238 cells/3HPFs (range 74–737 cells/3HPFs) (P < 0.001). In conclusion, our findings indicate that in cases where serum analysis-based data are unavailable, anti-IgA immunostaining can be used for differential diagnosis of IgG4-RD.
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Acknowledgments
This work was partially supported by a Grant-in-Aid for Scientific Research (C) (No. JP 16K08666) from the Japan Society for the Promotion of Science; a Grant for Intractable Diseases (IgG4-related disease research program) from the Ministry of Health, Labor and Welfare, Japan; and the Practical Research Project for Rare/Intractable Diseases from the Japan Agency for Medical Research and Development (AMED).
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Manabe, A., Igawa, T., Takeuchi, M. et al. Immunohistochemical analysis of IgA expression differentiates IgG4-related disease from plasma cell-type Castleman disease. Med Mol Morphol 50, 34–41 (2017). https://doi.org/10.1007/s00795-016-0145-4
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DOI: https://doi.org/10.1007/s00795-016-0145-4