Cytologically proven IgG4-positive plasma cells in pleural effusion of a patient clinically compatible with IgG4-related disease

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  • 胸水中に IgG4 陽性形質細胞浸潤を証明できた, IgG4 関連疾患と考えられる 1 例

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Abstract

<p>Background : The cytopathologic features of body cavity effusion in patients with IgG4-related disease have not been well documented. We report a case clinically compatible with IgG4-related disease, in which cytological examination successfully proved the presence of IgG4-positive plasma cells in pleural effusion.</p><p>Case : Computed tomography demonstrated mild pleural thickening with bilateral pleural and pericardial effusion in a female patient in her 70 s. The serum levels of IgG and IgG4 were both elevated. Conventional cytology of the pleural effusion revealed numerous infiltrating plasma cells with small lymphocytes, but no malignant cells. Although IgG4-related disease was suspected, IgG4 positivity could not be readily demonstrated in the plasma cells, either on a cytological smear or biopsy tissues, and plasma cell neoplasia could not be excluded. Immunostaining of a cell block preparation demonstrated that more than 50% of the plasma cells were IgG4-positive, without evidence of clonal immunoglobulin light chain restriction. In addition to the clinical features, the infiltrating plasma cells in the pleural effusion were considered to be associated with IgG4-related disease.</p><p>Conclusion : Use of a cell block preparation of the pleural effusion, combined with conventional cytological evaluation, seems to be effective for diagnosis of IgG4-related disease.</p>

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