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

• Published in: Journal of oral pathology & medicine Vol. 51; no. 5; pp. 493 - 500
• Main Authors: Pereira, Glauce Guimarães, Pontes, Flávia Sirotheau Corrêa, Soares, Ciro Dantas, Carvalho, Maria Goretti Freire, Silva, Tarcília Aparecida, Calderaro, Débora Cerqueira, Ferreira, Gilda Aparecida, Tanure, Leandro Augusto, Souza, Lucas Lacerda, Rodrigues‐Fernandes, Carla Isabelly, Almeida, Oslei Paes, Fonseca, Felipe Paiva, Pontes, Hélder Antônio Rebelo
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01-05-2022
• Subjects: Autoimmune diseases; autoimmune rheumatic diseases; Biopsy; Exocrine glands; Immunoglobulin G; immunoglobulin G4‐related disease; Lip; Lymphocytes; Maxillofacial; Oral cavity; Parotid gland; Patients; Plasma cells; Rheumatology; Salivary gland; Steroid hormones; Submandibular gland; salivary gland; oral cavity; immunoglobulin G4-related disease; autoimmune rheumatic diseases; submandibular gland
• ISSN: 0904-2512; 1600-0714
• DOI: 10.1111/jop.13296

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.