Immunoglobulin G4-positive ascending thoracic aortitis may be prone to dissection.
OBJECTIVE
Immunoglobulin (Ig) G4-positive aortitis may determine outcome after surgery for ascending aorta. We evaluated IgG4 expression of dilated ascending aortic wall.


METHODS
The study consisted of 91 patients who underwent ascending aortic surgery. For histology, hematoxylin-eosin, elastase-van Gieson, and periodic acid-Schiff stainings were performed. The amount of T and B lymphocytes, plasma cells, macrophages, cell proliferation, and IgG4 positivity were determined by immunohistochemistry.


RESULTS
The aortic wall in 12 patients had IgG4 positivity that was always confined to the adventitia. Adventitial plasma cells were numerous in all but 2 of these patients (P < .0001). Aortitis was revealed in 2 patients (17%) with IgG4-positive staining of the aorta and in 6 patients (8%) with IgG4 negativity. IgG4 staining was significantly associated with total aortic wall inflammation (area under the curve, 0.865; standard error, 0.043; P = .000; 95% confidence interval, 0.779-0.950). The mean diameter of the ascending aorta was 69 ± 4.7 mm and 56 ± 1.1 mm in patients with IgG4 positivity and negativity, respectively (P < .004). Approximately half of the patients with IgG4 positivity had dissection (42%), compared with only 15 of 79 (19%) of the remaining patients (P = not significant). Two patients with IgG4 positivity had to undergo reoperation because of immediate postoperative dissection. Seven patients died, including 4 patients (33%) with IgG4 positivity; the remaining 3 patients (4%) were IgG4 negative (P < .005).


CONCLUSIONS
IgG4-positive ascending aortic wall was frequent in our study cohort (13%) and revealed aortic inflammation associated with dilatation.
Department of Pathology, Fimlab Laboratories, Tampere University Hospital and Tampere University, Tampere, Finland.
Henri
H
Kajander
Timo
T
Paavonen
Timo
T
Valo
Matti
M
Tarkka
Ari A
AA
Mennander
D063194:Adventitia / Q000276:immunology; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000276:immunology* / Q000473:pathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery; D001025:Aortitis / Q000150:complications / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000032:analysis; D016009:Chi-Square Distribution; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010950:Plasma Cells / Q000276:immunology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D007074:Immunoglobulin G