Oral and maxillofacial manifestations of IgG4-related disease: A clinicopathological study

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Pereira, Glauce Guimaraes ; Correa Pontes, Flavia Sirotheau ; Soares, Ciro Dantas ; Freire de Carvalho, Maria Goretti ; da Silva, Tarcilia Aparecida ; Calderaro, Debora Cerqueira ; Ferreira, Gilda Aparecida ; Tanure, Leandro Augusto ; de Souza, Lucas Lacerda ; Rodrigues-Fernandes, Carla Isabelly ; de Almeida, Oslei Paes ; Fonseca, Felipe Paiva ; Rebelo Pontes, Helder Antonio

• Document type: Journal article
• Source: JOURNAL OF ORAL PATHOLOGY & MEDICINE; v. 51, n. 5, p. 8-pg., 2022-04-11.

Abstract

Background IgG4-related disease is a fibroinflammatory and immune-mediated condition, which has extremely variable clinical manifestations. In this study, we aim to investigate the clinicopathological features of IgG4-related disease involving the oral and maxillofacial region. Methods Cases of IgG4-related disease manifesting in the oral and maxillofacial region were retrieved from three Brazilian institutions. Clinical and serological data were obtained from the patients' medical charts, while microscopic and immunohistochemical findings were revised by oral pathologists. Diagnosis followed the American College of Rheumatology/European League against Rheumatism criteria. Results Seven patients diagnosed with IgG4-related disease were included in this study. Women were affected in all analysed cases, with a mean age of 55.4 years. Two patients presented with the clinical involvement of more than one oral and maxillofacial anatomic site. Therefore, our sample comprised nine oral and maxillofacial anatomic sites affected by IgG4-related disease. The submandibular gland was affected in four cases, the tongue and the parotid gland in two cases each, and the palate in one case. In a few cases, exploratory lower lip biopsy was used as a diagnostic approach. A moderate-to-severe lymphoid infiltrate containing plasma cells and lymphocytes, with an increased IgG4/IgG ratio, was common. Treatment varied and steroids were the most frequently used (57.4%). Six patients remained alive, while one died from unknown causes. Conclusion Although major salivary glands are commonly affected by IgG4-related disease, the oral cavity can also be involved, and lower lip biopsy may be an auxiliary diagnostic tool. (AU)

• FAPESP's process: 17/14880-3 - Clinicopathological and immunohistochemical analysis of follicular lymphoid hyperplasias and lymphomas of the oral cavity
• Grantee: Oslei Paes de Almeida
• Support Opportunities: Regular Research Grants