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[IgG4-related salivary gland lesions].
Ter Arkh 2015; 87(8):92-102TA

Abstract

AIM

To provide the demographic, clinical, laboratory, radiological, morphological, and immunomorphological characteristics of IgG4-related sialoadenitis (IgG4-S), which allow the differential diagnosis with neuroendocrine, granulomatous, blood cancer lesions of the salivary gland (SG).

SUBJECTS AND METHODS

In the period 2004 to 2014, IgG4-S was diagnosed in 32 (11%) out of 289 patients with significantly enlarged parotid and submandibular glands (PG and SMG). Only 4 (9%) patients had isolated IgG4-related disease (IgG4-D) whereas involvement of a few organs ran as an IgG4-SD systemic disease in 29 (91%) patients.

RESULTS

There was a slight preponderance of women with a median onset age of 42 years. Enlargement of the SMG (52.7%), lesions of the nasal cavity and paranasal sinuses (37.2%), and enlargement of the lacrimal gland and orbital pseudotumors (31%) are the most common clinical manifestations at disease onset. A follow-up study indicated that along with involvements of SMG (97%), PG (72%), eye sockets (72%), nasal cavity and paranasal sinuses (56%), one third of the patients were found to have generalized lymphadenopathy, to frequently develop pulmonary, hepatic, pancreatic, renal injuries; and the disease ran within IgG4-SD. The laboratory manifestations were characterized by moderate eosinophilia and elevated blood IgE levels in one-third of the patients and by moderately higher erythrocyte sedimentation rate and hypergammaglobulinemia in 50%. The increased blood level of IgG (84%) and its subclass IgG4 (86.4%) is an indication for further verification of IgG4-D in patients with involvement of the major SG. Immunohistochemical examination, by measuring the concentration of IgG4-secreting plasma cells (PCs), and determination of B-cell clonality in biopsy specimens should be done to verify a diagnosis with IgG4-D.

CONCLUSION

The determination of blood IgG4 (>2 g/l) in patients with considerably enlarged major SG may suggest the presence of IgG4-S. Minimally invasively incised PG and SMG biopsies with their subsequent morphological and immunomorphological examinations should be performed to make an accurate diagnosis. More than 40% of IgG4-secreting PCs detected in SG tissue is evidence to diagnose IgG4-D.

Authors+Show Affiliations

V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia.V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia.V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia.V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia.V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia.V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia.N.N. Blokhin Russian Cancer Research Center, Moscow, Russia.N.N. Blokhin Russian Cancer Research Center, Moscow, Russia.Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.Research Institute of Eye Diseases, Moscow, Russia.A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia.A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia.

Pub Type(s)

English Abstract
Journal Article

Language

rus

PubMed ID

26824822

Citation

Vasilyev, V I., et al. "[IgG4-related Salivary Gland Lesions]." Terapevticheskii Arkhiv, vol. 87, no. 8, 2015, pp. 92-102.
Vasilyev VI, Sokol EV, Rodionova EB, et al. [IgG4-related salivary gland lesions]. Ter Arkh. 2015;87(8):92-102.
Vasilyev, V. I., Sokol, E. V., Rodionova, E. B., Palshina, S. G., Aleksandrova, E. N., Radenska-Lopovok, S. G., ... Gaiduk, I. V. (2015). [IgG4-related salivary gland lesions]. Terapevticheskii Arkhiv, 87(8), pp. 92-102. doi:10.17116/terarkh201587892-102.
Vasilyev VI, et al. [IgG4-related Salivary Gland Lesions]. Ter Arkh. 2015;87(8):92-102. PubMed PMID: 26824822.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [IgG4-related salivary gland lesions]. AU - Vasilyev,V I, AU - Sokol,E V, AU - Rodionova,E B, AU - Palshina,S G, AU - Aleksandrova,E N, AU - Radenska-Lopovok,S G, AU - Probatova,N A, AU - Kokosadze,N V, AU - Kovrigina,A M, AU - Safonova,T N, AU - Borovskaya,A B, AU - Gaiduk,I V, PY - 2016/1/30/entrez PY - 2016/1/30/pubmed PY - 2016/1/30/medline SP - 92 EP - 102 JF - Terapevticheskii arkhiv JO - Ter. Arkh. VL - 87 IS - 8 N2 - AIM: To provide the demographic, clinical, laboratory, radiological, morphological, and immunomorphological characteristics of IgG4-related sialoadenitis (IgG4-S), which allow the differential diagnosis with neuroendocrine, granulomatous, blood cancer lesions of the salivary gland (SG). SUBJECTS AND METHODS: In the period 2004 to 2014, IgG4-S was diagnosed in 32 (11%) out of 289 patients with significantly enlarged parotid and submandibular glands (PG and SMG). Only 4 (9%) patients had isolated IgG4-related disease (IgG4-D) whereas involvement of a few organs ran as an IgG4-SD systemic disease in 29 (91%) patients. RESULTS: There was a slight preponderance of women with a median onset age of 42 years. Enlargement of the SMG (52.7%), lesions of the nasal cavity and paranasal sinuses (37.2%), and enlargement of the lacrimal gland and orbital pseudotumors (31%) are the most common clinical manifestations at disease onset. A follow-up study indicated that along with involvements of SMG (97%), PG (72%), eye sockets (72%), nasal cavity and paranasal sinuses (56%), one third of the patients were found to have generalized lymphadenopathy, to frequently develop pulmonary, hepatic, pancreatic, renal injuries; and the disease ran within IgG4-SD. The laboratory manifestations were characterized by moderate eosinophilia and elevated blood IgE levels in one-third of the patients and by moderately higher erythrocyte sedimentation rate and hypergammaglobulinemia in 50%. The increased blood level of IgG (84%) and its subclass IgG4 (86.4%) is an indication for further verification of IgG4-D in patients with involvement of the major SG. Immunohistochemical examination, by measuring the concentration of IgG4-secreting plasma cells (PCs), and determination of B-cell clonality in biopsy specimens should be done to verify a diagnosis with IgG4-D. CONCLUSION: The determination of blood IgG4 (>2 g/l) in patients with considerably enlarged major SG may suggest the presence of IgG4-S. Minimally invasively incised PG and SMG biopsies with their subsequent morphological and immunomorphological examinations should be performed to make an accurate diagnosis. More than 40% of IgG4-secreting PCs detected in SG tissue is evidence to diagnose IgG4-D. SN - 0040-3660 UR - https://www.unboundmedicine.com/medline/citation/26824822/[IgG4_related_salivary_gland_lesions]_ DB - PRIME DP - Unbound Medicine ER -