Study demonstrates Transition Defect (TD) or Transition Ambiguiety (TA)
This study by Prof Abbas et al of German Pathology Institute is in the very important domain of transitional medicine, requiring molecular definition and designation for the lesions or morbid entities previously held diagnosable on the histopathological basis with or without special staining. Molecular basis of defining disease as in the case under consideration of IgG-4 related systemic disease, is to take into account the molecule(s), like IgG-4 here, so varied histopathological inflammatory, sclerotic, fibrotic, and phlebitic entities in bone, joint, pancreas, salivary glands, skin, lymph nodes or else, if present with serum IgG-4 elevation/ presence of IgG-4 plasma cells, such lesions/morbidities are being by the researchers labelled as IgG-4 associated inflammatory expression diseases (Kim HJ 2000, Fragoulis GE 2010, Stone JR 2011). As evident in the present study, there may be IgG-4 plasmoinflammatory (mean 55/hpf) Rheumatoid (RF+ve) Synovitis, and IgG-4 plasmoinflammatory Rheumatoid factor negative (RF-ve) Synovitis as also reported by previous studies above. Likewise in oral including neoplastic lesions, skin diseases previously defined as allergies like pemphigus, Salivary sclerotic inflammations; where ever lesion is accompanied by tumifective inflammatory component and shows serum IgG-4 above normal levels and/or IgG-4 plasma cells infiltration 5-50 or more cells/hpf, the diagnostician is bound to tag diagnosis as IgG-4 associate say Rheumatoid arthritis. As such any anti nuclear, anti cytoplasm or anti membranous features could not be demonstrated in the IgG-4 or related plasma cells, which also appeared to be consequence of (B lymphocyte irritation) disease rather than cause. Hence designations like IgG-4 associated disease may not be proper in view of the consequent confusion. Better it may be identified as a common feature in several varied inflammation manifesting diseases requiring treatment for IgG-4 plasmoinflammation, besides for the cause and symptoms of the disease. What the authors concluded in this study appeared to constitute IgG-4 related transition defect (TD) or transition ambiguity (TA).
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