title: Dermatopathic Lymphadenopathy With Increased IgG4-Positive Plasma Cells.
abstract: Both dermatopathic lymphadenopathy (DL) and immunoglobulin G4-related disease (IgG4-RD) are frequently complicated with allergic diseases. However, the relationship between DL and IgG4-RD is not well known. To clarify this relationship on the basis of clinical and pathological findings, including IgG4-positive (IgG4+) plasma cell infiltration in lymph nodes (LNs) of DL patients, we analyzed LNs of 11 DL patients using immunostaining of IgG, IgG4, forkhead box P3 (FOXP3), transforming growth factor (TGF)-β, interferon (IFN)-γ, and matrix metalloproteinase (MMP)-1, MMP-8, and MMP-13. Toluidine blue staining was also performed to identify mast cells. Of 3 patients with a high ratio of IgG4+/IgG+ cells (>40%) and elevated serum IgG4 levels, 2 developed IgG4-RD, whereas the other patient did not. Of 8 patients with a low ratio of IgG4+/IgG+ cells (<40%) or no infiltration of IgG4+ cells, 5 who could be followed did not develop IgG4-RD. The numbers of mast cells were similar to those of TGF-β-positive cells, and serial sections showed that mast cells possibly produce TGF-β. LNs of DL patients with a high ratio of IgG4+/IgG+ cells had significantly more mast cells and TGF-β-positive cells than those of patients with a low ratio of IgG4+/IgG+ cells or no infiltration of IgG4+ cells. However, no fibrosis was observed in LNs of both groups. IFN-γ was positive in interdigitating dendritic cells, Langerhans cells, and macrophages. MMP-1, MMP-8, or MMP-13 was expressed in macrophages. The lack of fibrosis in LNs may have been due to the production of IFN-γ, MMP-1, MMP-8, or MMP-13. Thus, DL with increased IgG4+ cells seems to be a phenotype of IgG4-RD in LNs.
authors.affiliation: From the Department of Internal Medicine (I) (SN, TY, TA, TM, YH, NH, KI, AT, UN, YM, TH); Division of Mathematics (YN); Division of Surgical Pathology (MT), Osaka Medical College, Osaka, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Nakayama
authors.forename: Taiji
authors.initials: T
authors.lastname: Yokote
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Akioka
authors.forename: Takuji
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hirata
authors.forename: Nobuya
authors.initials: N
authors.lastname: Hiraoka
authors.forename: Kazuki
authors.initials: K
authors.lastname: Iwaki
authors.forename: Ayami
authors.initials: A
authors.lastname: Takayama
authors.forename: Uta
authors.initials: U
authors.lastname: Nishiwaki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Masuda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hanafusa
authors.forename: Yasuichiro
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Motomu
authors.initials: M
authors.lastname: Tsuji
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D051858:Forkhead Transcription Factors / Q000378:metabolism; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism*; D007371:Interferon-gamma / Q000378:metabolism; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology*; D008206:Lymphatic Diseases / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D008297:Male; D053505:Matrix Metalloproteinases, Secreted / Q000378:metabolism; D008875:Middle Aged; D010950:Plasma Cells / Q000502:physiology*; D012871:Skin Diseases / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D016212:Transforming Growth Factor beta / Q000378:metabolism
chemical_list: C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors; D007074:Immunoglobulin G; D016212:Transforming Growth Factor beta; D007371:Interferon-gamma; D053505:Matrix Metalloproteinases, Secreted