Immunostaining of Immunoglobulin G4 in the Lacrimal Sac
Yasuhiro Takahashi1, Hiroshi Ikeda2, Emiko Takahashi3
1a Departments of Oculoplastic, Orbital and Lacrimal Surgery , Aichi Medical University Hospital , Nagakute , Aichi , Japan.
Insights
Immunoglobulin G4 (IgG4) positive lymphoplasmacytic infiltration was found in lacrimal sac walls during dacryocystorhinostomy. This infiltration may cause narrowing of the lacrimal sac lumen and adhesions.
Area of Science:
- Ophthalmology
- Immunohistochemistry
- Pathology
Background:
- Dacryocystorhinostomy is a surgical procedure to restore lacrimal drainage.
- Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition affecting various organs.
Purpose of the Study:
- To investigate the presence and extent of immunoglobulin G4 (IgG4) positive lymphoplasmacytic infiltration in lacrimal sac walls.
- To correlate IgG4 staining patterns with histopathological findings in specimens from dacryocystorhinostomy.
Main Methods:
- Immunohistochemical staining for IgG4 was performed on 44 lacrimal sac wall specimens.
- Specimens were categorized as "intensively positive," "sparsely positive," or "negative" based on IgG4-positive cell density.
Main Results:
- IgG4-positive staining was observed in 50% of specimens (22/44), with 18.2% (8/44) being intensively positive and 31.8% (14/44) sparsely positive.
- Subepithelial infiltration of IgG4-positive cells was noted in all positive specimens.
- Partial epithelial denudation and goblet cell loss were observed in 4 of the 8 intensively positive specimens.
Conclusions:
- IgG4-positive lymphoplasmacytic infiltration is present in the subepithelial layer of lacrimal sac walls.
- This infiltration, particularly when intensive, may be associated with epithelial changes like denudation and goblet cell loss.
- These findings suggest a potential role for IgG4 in lacrimal sac pathology, possibly contributing to lumen narrowing and adhesions.
Purpose:
To immunohistochemically examine the lacrimal sac walls harvested during dacryocystorhinostomy using an immunostain for immunoglobulin G4 (IgG4).
Methods:
Forty-four lacrimal sac walls were evaluated. We determined "intensively positive," "sparsely positive," or "negative" staining when the specimens showed IgG4-positive lymphoplasmacytic staining with or without >50 IgG4-positive cells/high-power field, or the absence of stained IgG4-positive cells.
Results:
Intensively positive, sparsely positive, or negative staining was observed in 8 (18.2%), 14 (31.8%), and 22 specimens (50.0%), respectively. Stained cells infiltrated the subepithelial layer in all specimens with positive staining. Four of the 8 specimens demonstrated partial epithelial denudation with loss of goblet cells.
Conclusions:
IgG4-positive lymphoplasmacytic infiltration was observed in the subepithelial layer in specimens with intensively positive staining, of which some showed a partially denuded epithelium with loss of goblet cells. These may lead to narrowing of the lacrimal sac lumen and adhesions of the sac walls.
