Inflammatory Fibroid Polyps of Gastrointestinal Tract Rarely Show Increased IgG4 Expression

Livia Maccio, Silvia Lonardi, Fabio Facchetti, Anna Maria Cesinaro


Inflammatory Fibroid Polyp (IFP) of gastrointestinal tract is characterized by concentric perivascular fibrosis and a mixed inflammatory infiltrate rich in eosinophils and also few plasma cells. IgG4-related sclerosing diseases (IgG4-RSD) are a heterogenous group of disorders described in many organs, characterized by a significant increased of IgG4+ plasma cells in a context of storiform fibrosis, obliterative vasculitis and mixed inflammatory infiltrate containing eosinophils. The histological similarities between IFP and IgG4-RSD prompted the present study in the attempt to find a possible link between IgG4 over-expression and IFP.

The expression of IgG4 and IgG was evaluated in a series of 23 cases of IFP belonging to 23 patients. All cases were reviewed by two pathologists and the histological diagnosis confirmed. Immunohistochemistry for antibodies anti-IgG, anti-IgG4, and anti-IgA was performed on all cases and the results were evaluated by two observers.

One case of IFP out of 23 (4.3%) fulfilled the IgG4-RSD histological criteria. The case did not differ histologically from the others. The patient did not present either a raised serological level of IgG4, nor other sign of IgG4-RSD.

IgG4 increased expression can be rarely observed in IFP. Steroid therapy in cases of IFP with abundant IgG4+ plasma cells, especially in patients with multiple tumors, could be considered as an alternative to surgical treatment.



Inflammatory fibroid polyp; Gastrointestinal tract; IgG4; IgG4-related disease; Immunohistochemistry

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