Overlapping Morphologic and Immunohistochemical Features of Hashimoto Thyroiditis and IgG4-Related Thyroid Disease

Phil Raess, Arlette Habashi, Edward El Rassi, Kresimira Milas, David Sauer, Megan Troxell

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Immunoglobulin G4-related disease (IgG4-RD) is an emerging clinicopathologic entity characterized by both IgG4+ plasma cell infiltration and fibrosis in one or more organs, prototypically pancreas or salivary/lacrimal glands. IgG4-RD in the thyroid (IgG4-RTD) is an area of active study, and the relationship between IgG4-RTD and Hashimoto thyroiditis is not fully delineated due to their overlapping histologic features. Retrospective review was performed of all thyroidectomy cases demonstrating lymphocytic inflammation at a single institution over a 4-year period. Approximately half (23/38) of patients had a clinical diagnosis of Hashimoto thyroiditis (HT). Nine of the 38 patients had increased absolute and relative numbers of IgG4+ plasma cells. Patients with a clinical diagnosis of HT had increased lymphoplasmacytic inflammation, but the relative proportion of IgG4+ plasma cells was not increased compared to patients without HT. There was no correlation between IgG4 levels and the amount of fibrosis in patients with or without HT. Patients identified as having the fibrosing variant of HT were not more likely to have increased levels of IgG4+ plasma cells than those without. There is significant morphologic and immunohistochemical overlap between HT and IgG4-RTD. Future studies to identify specific characteristics of IgG4-RTD involving the thyroid are necessary to accurately define this entity.

Original languageEnglish (US)
Article number12
Pages (from-to)170-177
Number of pages8
JournalEndocrine Pathology
Volume26
Issue number2
DOIs
StatePublished - Apr 22 2015

Fingerprint

Hashimoto Disease
Thyroid Diseases
Immunoglobulin G
Plasma Cells
Thyroid Gland
Immunoglobulins
Fibrosis
Inflammation
Lacrimal Apparatus
Thyroidectomy
Salivary Glands
Pancreas

Keywords

  • Fibrosing variant
  • Hashimoto thyroiditis
  • IgG4-related disease
  • Thyroid

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Overlapping Morphologic and Immunohistochemical Features of Hashimoto Thyroiditis and IgG4-Related Thyroid Disease. / Raess, Phil; Habashi, Arlette; El Rassi, Edward; Milas, Kresimira; Sauer, David; Troxell, Megan.

In: Endocrine Pathology, Vol. 26, No. 2, 12, 22.04.2015, p. 170-177.

Research output: Contribution to journalArticle

Raess, Phil ; Habashi, Arlette ; El Rassi, Edward ; Milas, Kresimira ; Sauer, David ; Troxell, Megan. / Overlapping Morphologic and Immunohistochemical Features of Hashimoto Thyroiditis and IgG4-Related Thyroid Disease. In: Endocrine Pathology. 2015 ; Vol. 26, No. 2. pp. 170-177.
@article{bcd760feb38c4006b40f4e8d041ec60b,
title = "Overlapping Morphologic and Immunohistochemical Features of Hashimoto Thyroiditis and IgG4-Related Thyroid Disease",
abstract = "Immunoglobulin G4-related disease (IgG4-RD) is an emerging clinicopathologic entity characterized by both IgG4+ plasma cell infiltration and fibrosis in one or more organs, prototypically pancreas or salivary/lacrimal glands. IgG4-RD in the thyroid (IgG4-RTD) is an area of active study, and the relationship between IgG4-RTD and Hashimoto thyroiditis is not fully delineated due to their overlapping histologic features. Retrospective review was performed of all thyroidectomy cases demonstrating lymphocytic inflammation at a single institution over a 4-year period. Approximately half (23/38) of patients had a clinical diagnosis of Hashimoto thyroiditis (HT). Nine of the 38 patients had increased absolute and relative numbers of IgG4+ plasma cells. Patients with a clinical diagnosis of HT had increased lymphoplasmacytic inflammation, but the relative proportion of IgG4+ plasma cells was not increased compared to patients without HT. There was no correlation between IgG4 levels and the amount of fibrosis in patients with or without HT. Patients identified as having the fibrosing variant of HT were not more likely to have increased levels of IgG4+ plasma cells than those without. There is significant morphologic and immunohistochemical overlap between HT and IgG4-RTD. Future studies to identify specific characteristics of IgG4-RTD involving the thyroid are necessary to accurately define this entity.",
keywords = "Fibrosing variant, Hashimoto thyroiditis, IgG4-related disease, Thyroid",
author = "Phil Raess and Arlette Habashi and {El Rassi}, Edward and Kresimira Milas and David Sauer and Megan Troxell",
year = "2015",
month = "4",
day = "22",
doi = "10.1007/s12022-015-9368-5",
language = "English (US)",
volume = "26",
pages = "170--177",
journal = "Endocrine Pathology",
issn = "1046-3976",
publisher = "Humana Press",
number = "2",

}

TY - JOUR

T1 - Overlapping Morphologic and Immunohistochemical Features of Hashimoto Thyroiditis and IgG4-Related Thyroid Disease

AU - Raess, Phil

AU - Habashi, Arlette

AU - El Rassi, Edward

AU - Milas, Kresimira

AU - Sauer, David

AU - Troxell, Megan

PY - 2015/4/22

Y1 - 2015/4/22

N2 - Immunoglobulin G4-related disease (IgG4-RD) is an emerging clinicopathologic entity characterized by both IgG4+ plasma cell infiltration and fibrosis in one or more organs, prototypically pancreas or salivary/lacrimal glands. IgG4-RD in the thyroid (IgG4-RTD) is an area of active study, and the relationship between IgG4-RTD and Hashimoto thyroiditis is not fully delineated due to their overlapping histologic features. Retrospective review was performed of all thyroidectomy cases demonstrating lymphocytic inflammation at a single institution over a 4-year period. Approximately half (23/38) of patients had a clinical diagnosis of Hashimoto thyroiditis (HT). Nine of the 38 patients had increased absolute and relative numbers of IgG4+ plasma cells. Patients with a clinical diagnosis of HT had increased lymphoplasmacytic inflammation, but the relative proportion of IgG4+ plasma cells was not increased compared to patients without HT. There was no correlation between IgG4 levels and the amount of fibrosis in patients with or without HT. Patients identified as having the fibrosing variant of HT were not more likely to have increased levels of IgG4+ plasma cells than those without. There is significant morphologic and immunohistochemical overlap between HT and IgG4-RTD. Future studies to identify specific characteristics of IgG4-RTD involving the thyroid are necessary to accurately define this entity.

AB - Immunoglobulin G4-related disease (IgG4-RD) is an emerging clinicopathologic entity characterized by both IgG4+ plasma cell infiltration and fibrosis in one or more organs, prototypically pancreas or salivary/lacrimal glands. IgG4-RD in the thyroid (IgG4-RTD) is an area of active study, and the relationship between IgG4-RTD and Hashimoto thyroiditis is not fully delineated due to their overlapping histologic features. Retrospective review was performed of all thyroidectomy cases demonstrating lymphocytic inflammation at a single institution over a 4-year period. Approximately half (23/38) of patients had a clinical diagnosis of Hashimoto thyroiditis (HT). Nine of the 38 patients had increased absolute and relative numbers of IgG4+ plasma cells. Patients with a clinical diagnosis of HT had increased lymphoplasmacytic inflammation, but the relative proportion of IgG4+ plasma cells was not increased compared to patients without HT. There was no correlation between IgG4 levels and the amount of fibrosis in patients with or without HT. Patients identified as having the fibrosing variant of HT were not more likely to have increased levels of IgG4+ plasma cells than those without. There is significant morphologic and immunohistochemical overlap between HT and IgG4-RTD. Future studies to identify specific characteristics of IgG4-RTD involving the thyroid are necessary to accurately define this entity.

KW - Fibrosing variant

KW - Hashimoto thyroiditis

KW - IgG4-related disease

KW - Thyroid

UR - http://www.scopus.com/inward/record.url?scp=84937758604&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937758604&partnerID=8YFLogxK

U2 - 10.1007/s12022-015-9368-5

DO - 10.1007/s12022-015-9368-5

M3 - Article

VL - 26

SP - 170

EP - 177

JO - Endocrine Pathology

JF - Endocrine Pathology

SN - 1046-3976

IS - 2

M1 - 12

ER -