Clinical And Pathological Study On IgG4-related Ophthalmic Disease Of Lacrimal Gland

ObjectiveThrough exploring the characteristics of clinical manifestations,serology,imaging,and pathology of IgG4-ROD of the lacrimal gland,enhance the understanding of the disease.Further investigate differences of IgG4-ROD and non-specific inflammation disease through control studies.It will provide basis for clinical and pathological diagnosis,differential diagnosis and effective treatment.MethodsThis subject is a retrospective case study.40 cases lacrimal gland lesions were selected,confirmed by histopathology as "lymphocyte and plasma cell infiltration with fibrosis of lacrimal gland tissue" and ruled out lymphoma,epithelial tumor,mesenchymal tumor and metastasis tumor in Tianjin Eye Hospital from January 2003 to June 2017.The clinical manifestations,serological examinations,and imaging examinations were analyzed.HE staining and IgG and IgG4 antibody immunohistochemical staining techniques were performed on the pathological specimens.According to the latest diagnostic criteria,the cases were divided into IgG4-ROD group and non-IgG4-ROD group.The clinical and pathological features of the two groups were analyzed and statistical analysis was performed.ResultsOf the 40 cases,there were 15 cases IgG4-ROD and 25 cases non-IgG4-ROD.Compare the two groups and analyze the results:1.General clinical data: About the eye position,ocular protrusions,ptosis,and the clear boundary of the tumor,the significant statistic difference was observed between the two groups(P<0.05);And age,gender,duration of disease,eyelid swelling,peripheral pain,diplopia,eyeball displacement and movement limitation were not statistically significant between the two groups.2.Histopathology: About lymphocyte plasma cell infiltration,plasma cell number,number of lymphoid follicle formation,and striate fibrosis,there was a significant difference between the two groups(P<0.05);It is no statistically significant difference on interstitial fibrosis,eosinophills and occlusive phlebitis.3.Immunohistochemistry: About IgG4+ plasma cell number/HPF(Z=-5.271,P<0.05),IgG+ plasma cell number/HPF(Z=-4.006,P<0.05),IgG4+/IgG+ plasma cell ratio(Z=-5.268,P<0.05),there was a significant difference between the two groups.4.46.6% of IgG4-ROD patients were associated with other systemic-related diseases,and 12% of non-IgG4-ROD patients were associated with other diseases.5.Among the 10 cases IgG4-ROD patients with serological examination,9(90%)cases showed elevated serum in IgG and IgG4.Conclusions1.IgG4-ROD often occurs in middle-aged and older women and is more common in both eyes.The progression of the disease is slower.The most common manifestation is painless swelling of the lacrimal gland with nodular and clear boundary lesion.Nearly half of the patients have had suffering from other system-related diseases at the same time.2.Elevation of serological IgG4 is still an important clinical sign of IgG4-ROD.3.The lacrimal gland IgG4-ROD showed histopathological features,including: diffuse lymphocyte and plasma cell infiltration infiltration,a significant number of plasma cells,interstitial striate fibrosis,lymphoid follicle formation,a small amount of eosinophills and a large number of IgG4-positive plasma cells infiltration.But there is no sign of occlusive phlebitis.Non-IgG4-ROD performed slightly less.4.Immunohistochemical staining of IgG and IgG4 antibodies should be performed on inflammatory lesions with a large number of lymphocyte and plasma cells.When assessing the results of immunohistochemical staining of lacrimal gland IgG4-ROD,histopathological morphology should also be fully integrated.5.Clinical and imaging manifestations of both IgG4-ROD and non-IgG4-ROD of lacrimal gland often have some similarities,so the differential diagnosis is difficult.Therefore,for suspected cases,serological examination and pathological biopsy is still an important method of differential diagnosis.