Clinicopathological Study Of IgG4-related Orbital Inflammatory Pseudotumor

Clinicopathological study of IgG4-related orbital inflammatory pseudotumor OBJECTIVE:To investigate the clinical and histological differential diagnosis basis between IgG4-related orbital inflammatory pseudotumor(IgG4-ROIP)and non-IgG4-related orbital inflammatory pseudotumor(Non-IgG4-ROIP).METHODS:From October 2014 to October 2017,28 patients with palpebral inflammatory pseudotumor diagnosed by pathological examination at Tianjin Medical University Eye Hospital were selected.His pathological specimens were stained with HE and immunohistochemically labeled.According to the diagnostic criteria for related ocular diseases(IgG4-ROD)in 2014,this study was divided into two groups:IgG4-ROIP(9 cases)and Non-IgG4-ROIP(19 cases).Lymphoid follicle formation,tabular fibrosis and occlusive phlebitis were compared using chi-square test.Lymphocyte/plasma infiltration was examined by rank sum test.The immunohistochemical IgG4~+/HPF plasma cell number,IgG~+/HPF plasma cell number,and IgG4~+/IgG~+plasma cell ratio were compared using a two-sample t-test.The clinical manifestations and imaging features of patients were analyzed retrospectively,and the clinical imaging features of IgG4-ROIP and Non-IgG4-ROIP were summarized.Results:The IgG4-ROIP and Non-IgG4-ROIP groups had statistically significant differences in the following parameters:IgG4~+/HPF plasma cell number(P<0.01),and IgG~+/HPF plasma cell number(P<0.01),IgG4~+/IgG~+plasma cell ratio(P<0.01),lymphocyte and plasma cell infiltration(P=0.03),lymphoid follicle formation(P=0.01),but in striated fibers There was no statistically significant difference between P(0.99)and occlusive phlebitis(P=0.53).In the IgG4-ROIP group,9 cases of CT showed the most common involvement of lacrimal gland,mainly bilateral,unclear borders,extraocular muscle involvement,thickening of the inferior tibial nerve in 3 cases,bilateral parotid swelling in 6 cases,lymphadenopathy Large case.The non-IgG4-ROIP group 19 cases of lacrimal gland enlargement,orbital soft tissue mass,muscle thickening,thickening of the optic nerve and other performance are visible,a wide range of involvement,but no significant infraorbital nerve enlargement and lymphadenopathy.Conclusions:IgG4-ROIP often presents with diffuse swelling of bilateral lacrimal glands,which may be accompanied by thickening of branches of the trigeminal nerve.Bilateral nfraorbital nerve enlargement is more common.Bilateral inferior tibial nerve thickening is a characteristic imaging manifestation of the disease,and can be used as an early identification basis for non-IgG4-related endoplasmic inflammatory pseudotumor.A large number of IgG4~+plasma cell infiltrate and>40%of IgG4~+cells/IgG~+cells are pathological features that distinguish them from inflammatory pseudotumors.Clinical diagnosis,imaging data,and pathological examinations must be combined with clinical diagnosis to avoid maximally missed diagnosis and misdiagnosis.