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Chronic gastric ulceration: a novel manifestation of IgG4-related disease?
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Journal Article
Chronic gastric ulceration: a novel manifestation of IgG4-related disease?
2012
Overview
Immunohistochemistry reveals prominent IgG4-positive plasma cells within the inflammatory cell infiltrate. 1 The precise number of IgG4-positive plasma cells required per high power microscope field (or per unit area) in order to provide significant support to a diagnosis of IgG4-related disease is currently the subject of debate, with figures between >10 and >50 such cells per high power microscope field suggested by different groups. 2 It has become more recently apparent that the ratio of IgG4-positive plasma cells to the total number of IgG-positive plasma cells may be at least as important as the number of IgG4-positive plasma cells alone. Recurrence can occur on cessation of steroid therapy and sometimes alternative immunosuppressants are required, for example, azathioprine. 1 Liver Portal inflammation, large bile duct obstruction, portal sclerosis, lobular hepatitis, canalicular cholestasis Gallbladder Chronic cholecystitis Lymph nodes Follicular hyperplasia Lung Interstitial pneumonia Colon Chronic colitis Gastric Chronic gastritis Retroperitoneum Retroperitoneal fibrosis Kidney Tubulointerstitial nephritis Bile duct Periductular inflammation and fibrosis Salivary gland Chronic sclerosing sialadenitis Ampulla Active chronic duodenitis Hypothalamus Lymphocytic hypophysitis Prostate Chronic inflammation, obliterative phlebitis, glandular atrophy Mediastinum Mediastinal fibrosis Thyroid Thyroiditis, hypothyroidism Orbit Pseudotumour 3 Meninges Chronic meningitis 4 IgG4-related disease has recently been described as a cause of non-neoplastic polyp formation in the stomach and colon. 5 Two previous studies, from Japan and Taiwan, have identified an increased prevalence of gastric ulceration in patients with autoimmune pancreatitis and this appears to be independent of Helicobacter pylori infection status. 6 7 In one of these studies, gastric biopsy material was obtained from some of the patients and this revealed prominence of IgG4-positive plasma cells within the gastric mucosa. 6 However, there is only one previous report, from Japan, of a patient presenting with refractory gastric ulcer that on resection was found to be associated with prominent IgG4-positive plasma cells. 8 Our case is the first report of a patient presenting in this way outside of Asia.
Publisher
BMJ Publishing Group Ltd and Association of Clinical Pathologists,BMJ Publishing Group LTD
