Inflammatory Fibroid Polyps of Gastrointestinal Tract Rarely Show Increased IgG4 Expression

Livia Maccio, Silvia Lonardi, Fabio Facchetti, Anna Maria Cesinaro

Abstract


Inflammatory Fibroid Polyp (IFP) of gastrointestinal tract is characterized by concentric perivascular fibrosis and a mixed inflammatory infiltrate rich in eosinophils and also few plasma cells. IgG4-related sclerosing diseases (IgG4-RSD) are a heterogenous group of disorders described in many organs, characterized by a significant increased of IgG4+ plasma cells in a context of storiform fibrosis, obliterative vasculitis and mixed inflammatory infiltrate containing eosinophils. The histological similarities between IFP and IgG4-RSD prompted the present study in the attempt to find a possible link between IgG4 over-expression and IFP.

The expression of IgG4 and IgG was evaluated in a series of 23 cases of IFP belonging to 23 patients. All cases were reviewed by two pathologists and the histological diagnosis confirmed. Immunohistochemistry for antibodies anti-IgG, anti-IgG4, and anti-IgA was performed on all cases and the results were evaluated by two observers.

One case of IFP out of 23 (4.3%) fulfilled the IgG4-RSD histological criteria. The case did not differ histologically from the others. The patient did not present either a raised serological level of IgG4, nor other sign of IgG4-RSD.

IgG4 increased expression can be rarely observed in IFP. Steroid therapy in cases of IFP with abundant IgG4+ plasma cells, especially in patients with multiple tumors, could be considered as an alternative to surgical treatment.

 


Keywords


Inflammatory fibroid polyp; Gastrointestinal tract; IgG4; IgG4-related disease; Immunohistochemistry

Full Text:

PDF

References


[1] Vanek, J. (1949). Gastric submucosal granuloma with eosinophilic infiltration. Am J Pathol, 25, 397-411.

[2] Huss, S., Wardelmann, E., & Goltz, D., et al. (2012). Activating PDGFRA mutations in inflammatory fibroid polyps occur in exons 12, 14 and 18 and are associated with tumour localization. Histopathology, 61, 59-68.

[3] Liu, T.-C., Lin, M.-T., Montgomery, E. A., & Singhi, A. D. (2013). Inflammatory fibroid polyps of the gastrointestinal tract. Spectrum of clinical, morphologic, and immunohistochemistry features. Am J Surg Pathol, 37, 586-592.

[4] Cheuk, W., Chan, J. K. (2010). IgG4-related sclerosing disease: A critical appraisal of an evolving clinicopathologic entity. Adv Anat Pathol, 17, 303-332.

[5] Deshpande, V., Zen, Y., & Chan, J. K., et al. (2012). Consensus statement on the pathology of IgG4-realetd disease. Mod Pathol , 25, 1181-1192.

[6] Lopes, J., Hochwald, S. N., Lancia, N., Dixon, L. R., & Ben-David, K. (2010). Autoimmune esophagitis: IgG4-related tumors of the esophagus. J Gastrointest Surg, 14, 1031-1034.

[7] Lee, H., Joo, M., Song, T. J, Chang, S. H., Kim, H., Kim, Y. S., & Ryoo, J. Y. (2011). IgG4-related sclerosing esophagitis: a case report. Gastrointest Endosc, 73, 834-

837.

[8] Baez, J. C., Hamilton, M. J., Bellizzi, A., & Mortelé, K. J. (2010). Gastric involvement in autoimmune pancreatitis: MDCT and histopathologic features. JOP, 11, 610-613.

[9] Kaji, R., Okabe, Y., & Ishida, Y., et al. (2010). Autoimmune pancreatitis presenting with IgG4-positive multiple gastric polyps. Gastrointest Endosc, 71, 420-422.

[10] Kim, do H., Kim, J.,& Park, do H., et al. (2012). Immunoglobulin G4-related inflammatory pseudotumor of the stomach. Gastrointest Endosc , 76, 451-452.

[11] Rollins, K. E., Mehta, S. P., O’Donovan, M., & Safranek, P. M. (2011). Gastric IgG4-related autoimmune fibrosclerosing pseudotumour: A Novel Location. ISNR Gastroenterol 873087.

[12] Chetty, R., Serra, S., Gauchotte, G., Maerkl, B., & Agaimy, A. (2011). Sclerosing nodular lesions of the gastrointestinal tract containing large number of IgG4 plasma cells. Pathology, 43, 31-35.

[13] Na, K. Y., Sung, J. Y., Jang, J. Y., Lim, S. J, Kim, G.Y., Park, Y. K., & Lee, J. H. (2012). Gastric nodular lesions caused by IgG4-related disease. Pathol Int , 62, 716-718.

[14] Fujita, T., Ando, T., Sakakibara, M., Hosoda, W., & Goto, H. (2010). Refractory gastric ulcer with abundant IgG4-positive plasma cell infiltration: A case report. World J Gastroeneterol, 16, 2183-2186.

[15] Bateman, A. C., Sommerlad, M., & Underwood, T. J. (2012). Chronic gastric ulceration: a novel manifestation of IgG4-related disease? J Clin Pathol, 65, 569-570.

[16] Hisa, T., Ohkubo, H., Shiozwa, S., Ishigame, H., Furutake, M., & Takamatsu, M. (2008). Lymphoplasmacytic granuloma localized to the ampulla of Vater: An ampullary lesion of IgG4-related systemic disease? Gastroenterol Endosc, 68, 1229-1232.

[17] Kuroda, Y., Fujioka, M., Kurosawa, K., & Ohashi, K. (2011). IgG4-related inflammatory pseudotumor of the ileal conduit. Pathol Int, 61, 47-48.

[18] Wong, D. D., Pillai, S. R., & Priyanthi, K. M., et al. (2012). IgG4-related sclerosing disease of the small bowel presenting as necrotizing mesenteric arteritis and a solitary jejunal ulcer. Am J Surg Pathol, 36, 929-934.

[19] Matsui, H., Watanabe, T., & Ueno, K., et al. (2009). Colonic polyposis associated with autoimmune pancreatitis. Pancreas, 38, 840-842.

[20] Bettington, M., Brown, I. S., Kumarasinghe, M. P., de Boer, B., Bettington, A., & Rosty, C. (2014). The challenging diagnosis of cronkhite-Canada syndrome in the upper gastrointestinal tract: A series of 7 cases with clinical follow-up. Am J Surg Pathol, 38, 215-23.

[21] Strehl, J. D., Hartmann, A., & Agaimy, A. (2011). Numerous IgG4-positive plasma cells are ubiquitous in diverse localised non-specific chronic inflammatory conditions and need to be distinguished from IgG4-related systemic disorders. J Clin Pathol, 64, 237-243.

[22] Koizumi, S., Kamisawa, T., & Kumura, S., et al. (2013). Immunoglobulin G4-related gastrointestinal diseases, are they immunoglobulin G4-related diseases? World J Gastroenterol, 19, 5769-5774.

[23] Kamisawa, T., Anjiki, H., & Egawa, N. (2010). Disappearence of an ampullary pseudotumor after steroid therapy for autoimmune pancreatitis. Gastrointest Endosc, 71, 110-114.

[24] Nishiyama, Y., Koyama, S., & Andoh, A., et al. (2003). Gastric inflammatory fibroid polyp treated with helicobacter pylori eradication therapy. Intern Med., 42, 263-267.

[25] Hirasaki, S., Matsubara, M., & Ikeda, F., et al. (2007). Gastric inflammatory fibroid polyp treated with Helicobacter pylori eradication therapy. Intern Med, 46, 855-858.




DOI: http://dx.doi.org/10.3968/gh.v2i1.5256

Refbacks

  • There are currently no refbacks.


Copyright (c)



Share us to:   

Reminder

If you have already registered in Journal A and plan to submit article(s) to Journal B, please click the CATEGORIES, or JOURNALS A-Z on the right side of the "HOME".


We only use three mailboxes as follows to deal with issues about paper acceptance, payment and submission of electronic versions of our journals to databases:
[email protected]; [email protected]; [email protected]

 Articles published in Gastroenterology and Hepatology are licensed under Creative Commons Attribution 4.0 (CC-BY).

 GASTROENTEROLOGY AND HEPATOLOGY Editorial office

Address: 1055 Rue Lucien-L'Allier, Unit #772, Montreal, QC H3G 3C4, Canada.
Telephone: 1-514-558 6138 
Website: Http://www.cscanada.net Http://www.cscanada.org 
E-mail:[email protected], [email protected]

Copyright © 2010 Canadian Research & Development Centre of Sciences and Cultures