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Are plasma cell-rich inflammatory conditions of the oral mucosa manifestations of IgG4-related disease?
  1. Hannah Cottom1,
  2. Alan J Mighell2,
  3. Alec High1,
  4. Adrian C Bateman3
  1. 1Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Department of Oral Medicine, Leeds School of Dentistry, Leeds, Yorkshire, UK
  3. 3Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Hannah Cottom, Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, LS9 7TF, UK; h.cottom{at}nhs.net

Abstract

Aim The aim of this study was to characterise plasma cell infiltrates, in terms of IgG4 positivity, in specific and non-specific plasma cell-rich chronic inflammatory conditions of the oral mucosa. Exploring the possibility that specific plasma cell-rich oral inflammatory conditions have association with or represent an oral manifestation of immunoglobulin G4-related disease (IgG4-RD).

Methods Ten patients with plasma cell-rich chronic inflammatory conditions of the oral mucosa were identified (seven—plasma cell mucositis and three—non-specific diffuse oral mucosal inflammation with ulceration). For each patient, the clinical record and H&E-stained sections were reviewed. Immunohistochemistry for IgG and IgG4 antibodies was performed on sections from the corresponding paraffin block, permitting calculation of the mean number of IgG4+ plasma cells per high-power field (HPF) and the IgG4+/IgG+ plasma cell ratio.

Results In all the cases, only one histological hallmark of IgG4-RD—a dense lymphoplasmacytic infiltrate—was seen. Review of the medical histories did not reveal any features representing other manifestations of IgG4-RD. The number of IgG4+ plasma cells exceeded 100 per HPF in half of the cases. Only two cases had an IgG4+/IgG+ plasma cell ratio of >40%; both of which were in the non-specific oral inflammatory group.

Conclusions Our study suggests that plasma cell mucositis does not meet microscopic criteria for IgG4-RD. It importantly reinforces the opinion that IgG4+ plasma cells are major components of chronic inflammation in the oral cavity and the pertinence of correct contextual interpretation of histopathological features with clinical findings.

  • ORAL PATHOLOGY
  • INFLAMMATION
  • IMMUNOGLOBULIN

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