Hashimoto's Thyroiditis with Increased IgG4-Positive Plasma Cells: Using Thyroid-Specific Diagnostic Criteria May Identify Early Phase IgG4 Thyroiditis

Thyroid ◽  
2020 ◽  
Vol 30 (2) ◽  
pp. 251-261 ◽  
Author(s):  
Yaqiong Li ◽  
Xinli Wang ◽  
Zhiyan Liu ◽  
Jiwei Ma ◽  
Xiaoyan Lin ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Hashimoto’S Thyroiditis ◽  
Early Phase ◽  
Plasma Cells ◽  
Hashimoto's Thyroiditis

Pathology

2020 ◽  
pp. 16-24
Keyword(s):  
T Cells ◽  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Lymphocytic Infiltration ◽  
Lymphoid Cells ◽  
Hashimoto's Thyroiditis ◽  
Gamma Delta T Cells ◽  
Cellular Infiltration ◽  
Pyramidal Lobe ◽  
Grade Iii

Grossly, thyroid enlargement in Hashimoto's thyroiditis (HT) is generally symmetrical, often with a characteristic conspicuous pyramidal lobe. The tissue involved by HT is pinkish-tan to frankly yellowish in color and tends to have a rubbery firmness. There is no necrosis or calcification. The capsule is intact and non-adherent to peri-thyroid structures. Microscopically, there is a diffuse process consisting of a combination of epithelial cell destruction, lymphoid cellular infiltration, and fibrosis. Lymphocytes are predominantly T-cells and plasma cells. Most infiltrating T-cells have α/β T-cell receptors. Gamma/delta T-cells are rare. Hashimoto's thyroiditis has been graded based on lymphocytic infiltration seen on cytology, into Grades 0-III, where Grade 0 means no lymphoid cells and Grade III severe lymphoid cell infiltration. Deposits of dense material representing IgG are found along the basement membrane on electron microscopy. This chapter explores the pathology of Hashimoto's disease.

scholarly journals IgG4-related Hashimoto’s thyroiditis – A new variant of a well known disease

2014 ◽  
Vol 58 (8) ◽  
pp. 862-868 ◽  
Author(s):  
Henrique Vara Luiz ◽  
Diogo Gonçalves ◽  
Tiago Nunes da Silva ◽  
Isabel Nascimento ◽  
Ana Ribeiro ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Hashimoto's Thyroiditis ◽  
High Power Field ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Inflammatory Parameters ◽  
First Case ◽  
New Variant ◽  
Serum Igg4

Hashimoto’s thyroiditis (HT) has been characterized for many years as a well-defined clinicopathologic entity, but is now considered a heterogeneous disease. IgG4-related HT is a new subtype characterized by thyroid inflammation rich in IgG4-positive plasma cells and marked fibrosis. It may be part of the systemic IgG4-related disease. We report a case of a 56-year-old Portuguese man who presented with a one-month history of progressive neck swelling and dysphagia. Laboratory testing revealed increased inflammatory parameters, subclinical hypothyroidism and very high levels of thyroid autoantibodies. Cervical ultrasound (US) demonstrated an enlarged and heterogeneous thyroid gland and two hypoechoic nodules. US-guided fine needle aspiration cytology was consistent with lymphocytic thyroiditis. The patient was submitted to total thyroidectomy and microscopic examination identified typical findings of HT, marked fibrosis limited within the thyroid capsule and lymphoplasmacytic infiltration, with >50 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of >40%. After surgery, serum IgG4 concentration was high-normal. Symptoms relief and reduction in laboratory inflammatory parameters were noticed. Thyroid function is controlled with levothyroxine. To our knowledge we report the first case of IgG4-related HT in a non-Asian patient. We also perform a review of the literature regarding IgG4-related disease and IgG4-related HT. Our case highlights this new variant of the well known HT, and helps physicians in recognizing its main clinical features, allowing for proper diagnosis and treatment.

The role of IgG4 (+) plasma cells in the association of Hashimoto's thyroiditis with papillary carcinoma

Apmis ◽  
2014 ◽  
Vol 122 (12) ◽  
pp. 1259-1265 ◽  
Author(s):  
Funda Taşli ◽  
Güliz Özkök ◽  
Asuman Argon ◽  
Didem Ersöz ◽  
Ayşe Yağci ◽  
...  
Keyword(s):  
Papillary Carcinoma ◽  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Hashimoto's Thyroiditis

scholarly journals Distribution of IgG4- and/or IgG-Positive Plasma Cells in Hashimoto’s Thyroiditis: An Immunohistochemical Study

Pathobiology ◽  
2010 ◽  
Vol 77 (5) ◽  
pp. 267-272 ◽  
Author(s):  
Masaru Kojima ◽  
Mitsuyoshi Hirokawa ◽  
Haruji Kuma ◽  
Eijun Nishihara ◽  
Nobuhide Masawa ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Immunohistochemical Study ◽  
Hashimoto's Thyroiditis

IgG4-Positive Plasma Cells: A Marker of Fibrotic Variant of Hashimoto's Thyroiditis.

2010 ◽  
pp. P2-121-P2-121
Author(s):  
Y Li ◽  
K Hirayama ◽  
E Nishihara ◽  
Z Liu ◽  
T Ozaki ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Hashimoto's Thyroiditis

scholarly journals Extraosseous Plasmacytoma of Thyroid Arising in Hashimoto’s Thyroiditis

2020 ◽  
Vol 4 (1) ◽  
pp. 6-16
Author(s):  
Matthew Crabtree ◽  
Ping Ji ◽  
Cai Jennifer Cindy ◽  
Xin Qing
Keyword(s):  
Thyroid Gland ◽  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Organ Damage ◽  
Extramedullary Plasmacytoma ◽  
Hashimoto's Thyroiditis ◽  
Pcr Analysis ◽  
Gene Rearrangements ◽  
Histologic Diagnosis ◽  
Diffuse Infiltration

Plasma cell neoplasms of the thyroid gland are uncommon. They may occur either as a primary extraosseous (extramedullary) plasmacytoma or as secondary involvement by multiple myeloma (MM). Here, we report the case of a 62-year-old female, presenting with goiter and Hashimoto’s thyroiditis, in whom the histologic diagnosis of extraosseous plasmacytoma was unexpected. Histology of the total thyroidectomy specimen showed a diffuse infiltration of well-differentiated plasma cells against a background of Hashimoto’s thyroiditis. By immunohistochemistry, the majority of the plasma cells are positive for IgG heavy chain and kappa light chain (kappa:lambda ratio was about 6-7:1). PCR analysis of the immunoglobulin heavy and kappa chain (IGH, IGK) gene rearrangements showed clonal IGH and IGK gene rearrangements. MM was ruled out by lack of MM-related end organ damage and negative serum protein electrophoresis, immunofixation, and bone marrow biopsy. Although rare, plasmacytoma should be considered in patients presenting with enlarging thyroid gland and autoimmune thyroiditis. Histologic diagnosis and differential diagnoses are comprehensively discussed.

scholarly journals Medical Cure of Plasma Cell Granuloma of the Thyroid Associated with Hashimoto’s Thyroiditis: A Case Report and Review

2004 ◽  
Vol 89 (4) ◽  
pp. 1534-1537 ◽  
Author(s):  
Silvana Laurent ◽  
Luc Mouthon ◽  
Elisabeth Longchampt ◽  
Marie Roudaire ◽  
Sylvia Franc ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Plasma Cell ◽  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Thyroid Volume ◽  
Good Alternative ◽  
Plasma Cell Granuloma ◽  
Hashimoto's Thyroiditis ◽  
Fibrotic Process ◽  
Life Threatening

Abstract Plasma cell granuloma (PCG) is a rare, benign inflammatory tumor composed of myofibroblasts, abundant plasma cells, and lymphocytes combined with collagen. A thyroid localization of PCG is extremely rare, and surgical therapy is indicated. We report the case of a 35-yr-old woman with a thyroid PCG, associated with Hashimoto’s thyroiditis, that was responsible for tracheal compression. Surgery was performed, but the thyroid could not be removed because of the fibrotic process. The patient was treated with corticosteroids and immunosuppressive therapy. Dyspnea and dysphagia improved within 1 month, whereas thyroid volume returned to normal within 3 yr. We also review other reports of thyroid PCG in the literature and discuss the differential diagnosis and treatment. Although the use of immunosuppressive therapy has never been reported for thyroid PCG until now, this treatment may represent a good alternative to surgery in life-threatening, unresectable PCG.

IgG4-related disease of the thyroid gland

2021 ◽  
Vol 14 (3) ◽  
pp. e238177
Author(s):  
Tânia Matos ◽  
Margarida Mendes de Almeida ◽  
Lucas Batista ◽  
Sónia do Vale
Keyword(s):  
Thyroid Gland ◽  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Needle Aspiration ◽  
Hashimoto's Thyroiditis ◽  
Fine Needle ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Cervical Swelling ◽  
Reduced Mobility

IgG4-thyroid-related disease (TRD) represents an uncommon spectrum of diseases, with four subcategories established so far, IgG4-related Hashimoto’s thyroiditis, fibrosing variant of Hashimoto’s thyroiditis, Riedel’s thyroiditis and Graves disease with elevated IgG4 levels. We report the case of a 59-year-old woman presenting with painless cervical swelling and hypothyroidism. Thyroid gland was enlarged and distinctively very hard, with reduced mobility. Neck ultrasonography showed multiple nodularity and diffuse thyroid enlargement, which on CT scan conditioned slight deviation of the airway. Fine-needle aspiration of the biggest nodule was suggestive of lymphocytic thyroiditis. She developed compressive symptoms and was submitted to total thyroidectomy. Histology of the thyroid revealed extensive areas of fibrosis, oncocytic cells and lymphoplasmacytic infiltrates. Immunohistochemistry confirmed the predominance of IgG4-secreting plasma cells. IgG4-TRD is characterised by a rapidly progressive and destructive thyroiditis process. Typical presentation can often mimic malignancy; hence, an opportune recognition of IgG4-TRD may avoid unnecessary burdens.

scholarly journals Warthin-like papillary thyroid carcinoma with immunoglobulin G4-positive plasma cells possibly related to Hashimoto’s thyroiditis

2018 ◽  
Vol 65 (2) ◽  
pp. 175-180 ◽  
Author(s):  
Mitsuyoshi Hirokawa ◽  
Eijun Nishihara ◽  
Nami Takada ◽  
Miyoko Higuchi ◽  
Masumi Kotakemori ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Hashimoto’S Thyroiditis ◽  
Plasma Cells ◽  
Hashimoto's Thyroiditis ◽  
Papillary Thyroid ◽  
Immunoglobulin G4
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