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Evaluating breast lymphoplasmacytic infiltrates: a multiparameter immunohistochemical study, including assessment of IgG4.
Hum Pathol. 2015 Aug; 46(8):1162-70.HP

Abstract

Lymphoplasmacytic infiltrates in the breast, a modified skin appendage, include lymphocytic lobulitis, other nonspecific benign proliferations, and mucosa-associated lymphoid tissue (MALT)-type lymphoma. Distinguishing these entities, all of which may be B-cell rich and may have associated sclerosis, can be difficult. In addition, the proportion that represents IgG4-related disease is unknown, and the similarity of MALT lymphomas to primary cutaneous marginal zone lymphoma is uncertain. To address these questions, the clinical, histologic, and immunohistochemical features of 50 benign and malignant breast lymphoplasmacytic infiltrates (10 lymphocytic lobulitis, 1 granulomatous, 19 not otherwise specified, 20 MALT lymphomas) were evaluated. Compared with the MALT lymphomas, benign cases had a less dense infiltrate (P < .001), fewer but more histologically apparent germinal centers (P < .001), and more marked fibrosis (P < .0001). Greater than 60% B cells were present in 23% (7/30) benign cases versus 75% (15/20) MALT lymphomas (P = .0003). Plasma cells were predominantly IgG+ in 83% (24/29) benign cases and predominantly IgM+ in 73% (14/19) MALT lymphomas (P < .0001). None of the benign cases had greater than 50 IgG4+ plasma cells/high-power field, and only 1 lymphocytic lobulitis case had an IgG4/IgG ratio exceeding 40% and no clinical evidence for extramammary IgG4-related disease. Although there may be some overlapping features, routine histopathology together with limited immunohistochemical stains can distinguish benign from neoplastic lymphoplasmacytic infiltrates in the breast. Despite frequent sclerosis, the breast is not a common site of unrecognized IgG4-related sclerosing disease. Although there are similarities, breast MALT lymphomas can be separated from cutaneous marginal zone lymphoma.

Authors+Show Affiliations

Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.Department of Laboratory Medicine, University of Washington, Seattle, WA 98195.Department of Pathology, Division of Gynecologic and Breast Cancer Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213. Electronic address: garciac@upmc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26026200

Citation

Berg, Aaron N., et al. "Evaluating Breast Lymphoplasmacytic Infiltrates: a Multiparameter Immunohistochemical Study, Including Assessment of IgG4." Human Pathology, vol. 46, no. 8, 2015, pp. 1162-70.
Berg AN, Soma L, Clark BZ, et al. Evaluating breast lymphoplasmacytic infiltrates: a multiparameter immunohistochemical study, including assessment of IgG4. Hum Pathol. 2015;46(8):1162-70.
Berg, A. N., Soma, L., Clark, B. Z., Swerdlow, S. H., & Roth, C. G. (2015). Evaluating breast lymphoplasmacytic infiltrates: a multiparameter immunohistochemical study, including assessment of IgG4. Human Pathology, 46(8), 1162-70. https://doi.org/10.1016/j.humpath.2015.04.006
Berg AN, et al. Evaluating Breast Lymphoplasmacytic Infiltrates: a Multiparameter Immunohistochemical Study, Including Assessment of IgG4. Hum Pathol. 2015;46(8):1162-70. PubMed PMID: 26026200.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluating breast lymphoplasmacytic infiltrates: a multiparameter immunohistochemical study, including assessment of IgG4. AU - Berg,Aaron N, AU - Soma,Lorinda, AU - Clark,Beth Z, AU - Swerdlow,Steven H, AU - Roth,Christine G, Y1 - 2015/04/28/ PY - 2015/01/20/received PY - 2015/04/16/revised PY - 2015/04/17/accepted PY - 2015/6/1/entrez PY - 2015/6/1/pubmed PY - 2015/10/7/medline KW - Breast KW - IgG4 KW - Lymphoplasmacytic KW - MALT lymphoma KW - Sclerosis SP - 1162 EP - 70 JF - Human pathology JO - Hum. Pathol. VL - 46 IS - 8 N2 - Lymphoplasmacytic infiltrates in the breast, a modified skin appendage, include lymphocytic lobulitis, other nonspecific benign proliferations, and mucosa-associated lymphoid tissue (MALT)-type lymphoma. Distinguishing these entities, all of which may be B-cell rich and may have associated sclerosis, can be difficult. In addition, the proportion that represents IgG4-related disease is unknown, and the similarity of MALT lymphomas to primary cutaneous marginal zone lymphoma is uncertain. To address these questions, the clinical, histologic, and immunohistochemical features of 50 benign and malignant breast lymphoplasmacytic infiltrates (10 lymphocytic lobulitis, 1 granulomatous, 19 not otherwise specified, 20 MALT lymphomas) were evaluated. Compared with the MALT lymphomas, benign cases had a less dense infiltrate (P < .001), fewer but more histologically apparent germinal centers (P < .001), and more marked fibrosis (P < .0001). Greater than 60% B cells were present in 23% (7/30) benign cases versus 75% (15/20) MALT lymphomas (P = .0003). Plasma cells were predominantly IgG+ in 83% (24/29) benign cases and predominantly IgM+ in 73% (14/19) MALT lymphomas (P < .0001). None of the benign cases had greater than 50 IgG4+ plasma cells/high-power field, and only 1 lymphocytic lobulitis case had an IgG4/IgG ratio exceeding 40% and no clinical evidence for extramammary IgG4-related disease. Although there may be some overlapping features, routine histopathology together with limited immunohistochemical stains can distinguish benign from neoplastic lymphoplasmacytic infiltrates in the breast. Despite frequent sclerosis, the breast is not a common site of unrecognized IgG4-related sclerosing disease. Although there are similarities, breast MALT lymphomas can be separated from cutaneous marginal zone lymphoma. SN - 1532-8392 UR - https://www.unboundmedicine.com/medline/citation/26026200/Evaluating_breast_lymphoplasmacytic_infiltrates:_a_multiparameter_immunohistochemical_study_including_assessment_of_IgG4_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0046-8177(15)00143-4 DB - PRIME DP - Unbound Medicine ER -