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Case Reports
. 2024 Dec;17(4):227-230.
doi: 10.1007/s12308-024-00615-5. Epub 2024 Dec 4.

Perifollicular concentric granulomas: A clue to IgG4-related lymphadenopathy

Joanna L Conant  1 , Sean S M Bullis  2 , Clayton Wilburn  2
Affiliations
Case Reports

Perifollicular concentric granulomas: A clue to IgG4-related lymphadenopathy

Joanna L Conant et al. J Hematop. 2024 Dec.

Abstract

A 69-year-old with well-controlled HIV was evaluated for persistent cough, in the context of years of fatigue and influenza A infection 6 months prior. Chest CT and PET scans were notable for adenopathy concerning for a lymphoproliferative disorder. Radiologic studies also showed diffuse FDG uptake in the prostate, consistent with prostatitis. Axillary lymph node biopsy showed follicular and paracortical hyperplasia, and few germinal centers showed perifollicular non-necrotizing granulomas. Immunohistochemical staining demonstrated a predominance of IgG4 positive plasma cells. Serum protein electrophoresis (SPEP) and immunosubtraction showed a board-domed peak pattern suggestive of possible monoclonality. Serum IgG4 levels were elevated, and the patient was diagnosed with IgG4-related disease (IgG4-RD). This case highlights morphologic and SPEP patterns that can aid in supporting a diagnosis of IgG4-RD.

Keywords: Granulomas; IgG4 related disease; Lymphadenopathy; SPEP.

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Conflict of interest statement

Declarations. Ethics approval: All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: Informed consent was obtained from all the individual participants included in the study. Consent for publication: Consent for publication was obtained for every individual person’s data included in the study. Conflict of interest: The authors declare no competing interests.

References

    1. Deshpande V, Zen Y, Chan JK et al (2012) Consensus statement on the pathology of IgG4-related disease. Mod Pathol 25(9):1181–1192. https://doi.org/10.1038/modpathol.2012.72 - DOI - PubMed
    1. Liang L, Zhou J, Chen L (2015) Perifollicular granulomas with IgG4 plasmacytosis: a case report and review of literature. World J Clin Cases 3(7):650–654. https://doi.org/10.12998/wjcc.v3.i7.650 - DOI - PubMed - PMC
    1. Bledsoe JR, Ferry JA et al (2021) IgG4-related lymphadenopathy: a comparative study of 41 cases reveals distinctive histopathologic features. Am J Surg Pathol 45(2):178–192. https://doi.org/10.1097/PAS.0000000000001579 - DOI - PubMed
    1. Cheuk W, Bledsoe JR (2024) IgG4-related lymphadenopathy. Semin Diagn Pathol 41(2):108–115. https://doi.org/10.1053/j.semdp.2024.01.003 - DOI - PubMed
    1. Finn WG, Gulbranson R, Fisher S et al (2016) Detection of polyclonal increases in immunoglobulin G4 subclass by distinct patterns on capillary serum protein electrophoresis: diagnostic pitfalls and clinical observations in a study of 303 cases. Am J Clin Pathol 146(3):303–311. https://doi.org/10.1093/ajcp/aqw113 - DOI - PubMed

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