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M. Del Valle, R. L. Font; Ocular, Adnexal and Orbital Inflammatory Conditions Associated With Igg4-Positive Plasma Cells: A Histopathologic and Immunohistochemical Analysis of 14 Cases. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6315.
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To determine the presence of IgG4-positive plasma cells in inflammatory lesions involving the ocular, adnexal and the orbital structures.
We retrieved fourteen cases from our files of the Ophthalmic Pathology Laboratory at the Cullen Eye Institute, Baylor College of Medicine that were received from January 2007 to August 2009 including: eight sclerosing inflammatory pseudotumors (IPs) of the orbit, one case of Kimura’s disease of the orbit, two IPs involving the lacrimal gland, two lipogranulomatous inflammation of the eyelid and one active herpes simplex stromal keratitis. Sections were cut at 5 micra and stained with hematoxylin-eosin, the periodic-acid Schiff (PAS) and the Mason’s trichrome methods. Additionally, several monoclonal antibodies encompassing the following: CD68, CD3, CD20, and IgG4 were performed.
Histologically, the fourteen cases disclosed varying degrees of sclerosis, lymphoplasmacytic infiltrates, prominent chronic perivasculitis, eosinophilic infiltrates and IgG4 (+) plasma cells which were graded based on the number of positive plasma cells found per high power field (HPF). There were twelve women and two men with a mean age of 46 years ranging from 13 - 94 years. In twelve of the lesions there were prominent lymphoplasmacytic infiltrates (>100 cells per HPF) with an associated perivasculitis. The majority of the lymphocytes in the sections examined were CD3 positive-T cells. Five orbital lesions disclosed >50 IgG4-positive plasma cells per HPF, one case (lipogranulomatous inflammation of the eyelid) showed between 20-50 IgG4-positive plasma cells per HPF and five lesions were negative for the IgG4 antibody.
Our results demonstrate IgG4-positive plasma cells in nine inflammatory lesions involving the ocular and adnexal structures. The exact pathogenetic mechanism of this antibody in the IgG4-related conditions is still under study by researchers. The results of our study coupled with recent literature review may have a significant impact on the immunotherapy of these processes with IgG4 monoclonal antibodies.
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