title: Immunoglobulin G4-related disease of the hard palate.
abstract: A 71-year-old woman presented with erythematous, nontender, bilateral hard palate nodules of 6-month duration. Biopsy showed collagenous sclerosis and a follicular lymphoplasmacytic infiltrate among the minor salivary glands. Immunoglobulin G (IgG) and IgG4 staining showed 280 IgG4(+) cells per high-power field and a ratio of IgG4(+) to IgG(+) cells of 0.8. The patient subsequently developed bilateral lacrimal gland and parotid gland enlargement associated with an increased serum IgG4 level of 3,031 mg/dL (≤ 135 mg/dL). Left lacrimal gland biopsy confirmed IgG4-related dacryoadenitis. The patient declined corticosteroid treatment for IgG4-related disease (IgG4-RD) and remained stable at 15 months after the first presentation. Spontaneous, partial resolution of the palatal lesion was observed during follow-up. IgG4-RD should be considered in the differential diagnosis of lymphoplasmacytic lesions of the hard palate.
authors.affiliation: Associate Clinical Lecturer, Department of Ophthalmology and Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, South Australia, Australia. Electronic address: nick.h.andrew@gmail.com.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Andrew
authors.affiliation: Senior Consultant, Anatomic Pathologist, SA Pathology, Royal Adelaide Hospital and Department of Surgical Pathology, Institute of Medical and Veterinary Science, Adelaide, South Australia, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kearney
authors.affiliation: Registrar in Anatomical Pathology, SA Pathology, Royal Adelaide Hospital and Department of Surgical Pathology, Institute of Medical and Veterinary Science, Adelaide, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Sladden
authors.affiliation: Emeritus Consultant, Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Alastair
authors.initials: A
authors.lastname: Goss
authors.affiliation: Foundation Chair, Department of Ophthalmology and Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, South Australia, Australia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000368:Aged; D003607:Dacryocystitis / Q000276:immunology; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis* / Q000097:blood; D021362:Palate, Hard / Q000473:pathology*; D010265:Paraproteinemias / Q000175:diagnosis*; D010309:Parotitis / Q000276:immunology; D012075:Remission, Spontaneous; D012470:Salivary Glands, Minor / Q000473:pathology; D012598:Sclerosis / Q000276:immunology; D012793:Sialadenitis / Q000276:immunology
chemical_list: D007074:Immunoglobulin G