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Overlapping Morphologic and Immunohistochemical Features of Hashimoto Thyroiditis and IgG4-Related Thyroid Disease

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Abstract

Immunoglobulin G4-related disease (IgG4-RD) is an emerging clinicopathologic entity characterized by both IgG4+ plasma cell infiltration and fibrosis in one or more organs, prototypically pancreas or salivary/lacrimal glands. IgG4-RD in the thyroid (IgG4-RTD) is an area of active study, and the relationship between IgG4-RTD and Hashimoto thyroiditis is not fully delineated due to their overlapping histologic features. Retrospective review was performed of all thyroidectomy cases demonstrating lymphocytic inflammation at a single institution over a 4-year period. Approximately half (23/38) of patients had a clinical diagnosis of Hashimoto thyroiditis (HT). Nine of the 38 patients had increased absolute and relative numbers of IgG4+ plasma cells. Patients with a clinical diagnosis of HT had increased lymphoplasmacytic inflammation, but the relative proportion of IgG4+ plasma cells was not increased compared to patients without HT. There was no correlation between IgG4 levels and the amount of fibrosis in patients with or without HT. Patients identified as having the fibrosing variant of HT were not more likely to have increased levels of IgG4+ plasma cells than those without. There is significant morphologic and immunohistochemical overlap between HT and IgG4-RTD. Future studies to identify specific characteristics of IgG4-RTD involving the thyroid are necessary to accurately define this entity.

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Acknowledgments

The authors wish to acknowledge Linh Matsumura for her expert immunohistochemical skills and Alex Bolinder for assistance with figure preparation.

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Authors and Affiliations

  1. Department of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    Philipp W. Raess, Arlette Habashi, David A. Sauer & Megan L. Troxell

  2. Department of Otolaryngology, Oregon Health & Science University, Portland, OR, 97239, USA

    Edward El Rassi & David A. Sauer

  3. Department of Surgery, Oregon Health & Science University, Portland, OR, 97239, USA

    Mira Milas

Authors
  1. Philipp W. Raess
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  2. Arlette Habashi
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  3. Edward El Rassi
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  4. Mira Milas
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  5. David A. Sauer
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  6. Megan L. Troxell
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Correspondence to Philipp W. Raess.

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Raess, P.W., Habashi, A., El Rassi, E. et al. Overlapping Morphologic and Immunohistochemical Features of Hashimoto Thyroiditis and IgG4-Related Thyroid Disease. Endocr Pathol 26, 170–177 (2015). https://doi.org/10.1007/s12022-015-9368-5

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  • DOI: https://doi.org/10.1007/s12022-015-9368-5

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