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IgG4-related disease: can non-classical histopathological features or the examination of clinically uninvolved tissues be helpful in the diagnosis?
  1. Emma L Culver1,2,
  2. Adrian C Bateman3
  1. 1Nuffield Department of Medicine, University of Oxford, Oxford, UK
  2. 2Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
  3. 3Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Adrian C Bateman, Department of Cellular Pathology, MP002, Level E, South Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; adrian.bateman{at}


IgG4-related disease (IgG4-RD) is an increasingly recognised inflammatory and fibrosing condition that commonly shows multisystem involvement. The disease may mimic malignancy and other inflammatory or immune-mediated disorders, but usually has a good response to corticosteroid therapy, underlining the requirement for recognition of the condition. Accurate diagnosis requires careful interpretation of varying combinations of serum IgG4 levels, radiological features and characteristic histopathological appearances within an appropriate clinical setting. The presence of ‘classical’ histopathological features together with an elevated tissue IgG4+ plasma cell count and IgG4 to IgG ratio is often diagnostic and at the very least can strongly support a clinicopathological diagnosis of IgG4-RD. The authors describe the most recent diagnostic criteria for IgG4-RD, especially the histopathological features. The authors then discuss the merits of examining tissues that may be more easily obtainable than those that commonly show the ‘classical’ histopathological features, but within which not all of these ‘diagnostic’ features may be present. The authors conclude that while a combination of ‘classical’ histopathological features and an elevated tissue IgG4+ plasma cell count is the gold standard for diagnosis, examination of tissues that show some but not all of these features can, in the appropriate context, provide useful supporting evidence for a clinicopathological diagnosis of IgG4-RD.

  • Immunoglobulin
  • inflammation
  • fibrosis

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  • Funding ELC receives funding from a Welcome Trust Research Fellowship into the pathogenesis of IgG4-related disease.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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