[605] IgG4+ Plasma Cells in Gastric Biopsies Specific for Patients with Autoimmune Atrophic Gastritis/Pernicious Anemia

AS Bedeir, JG Lash, MB Ray. Caris Diagnostics, Irving, TX

Background: Although initially described in autoimmune pancreatitis, the presence of increased IgG4 + plasma cells has also been noted in other autoimmune diseases and other organs. Autoimmune gastritis is characterized by anti-parietal and anti-intrinsic factor antibodies that can cause pernicious anemia (PA). Histologically, autoimmune gastritis manifests as a chronic atrophic gastritis (CATG) restricted to the corpus, but there are other causes of CATG, including Helicobacter infection. This study investigates the presence of IgG4+ plasma cells in gastric mucosal biopsies from patients with a variety of gastric histopathology, including CATG with and without PA.
Design: Archives were searched for patients with the histologic diagnosis of CATG and a history of PA (CATG+PA+, n=46). As controls, archives were searched for 25 patients each with the histologic diagnosis of CATG but no history of PA (CATG+ PA-), patients with normal histology, those with mild chronic inactive gastritis (MCIG), and those with the diagnosis of Helicobacter pylori gastritis (HP).Quantification of Ig G4+ plasma cells were obtained via two methods. 1. Immunohistochemical stain for IgG4 on formalin fixed paraffin embedded tissue. Areas with the highest density of IgG4+ plasma cells were selected, and the average of the 3 most cellular HPFs were counted. 2. To ensure that the number of IgG4+ cells was not simply related to the degree of inflammation (density of plasma cells), dual chromagen immunohistochemical stains for CD138/IgG4 were performed. Areas with the highest density of CD138+ plasma cells were selected, and the number of IgG4+ cells / 200 CD138+ plasma cells was counted. For both methods, the results are interpreted as follows: < 5 considered negative, 5 or more considered positive.
Results: Identical results were obtained by both staining methods. 17/46 (37%) PA patients were positive for increased IgG 4+ plasma cells in. All other groups were negative.

Table1
numberPositive
CATG+PA+4617 (37%)
CATG+PA-250
Normal250
MCIG250
HP250
CATG+PA+:chronic atrophic gastritis & pernicious anemia. CATG+PA-: chronic atrophic gastritis & NO pernicious anemia. MCIG: mild chronic inactive gastritis, HP: Helicobacter pylori gastritis.


Conclusions: Increased IgG4+ plasma cells was present in 37% of patients with CATG+ PA+ but not in those with CATG+PA-, MCIG, HP or normal gastric biopsies (100% specific in this study). IgG4+ plasma cells may play a role in the pathogenesis of PA.
Category: Gastrointestinal

Tuesday, March 23, 2010 11:00 AM

Platform Session: Section E, Tuesday Morning

 

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