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Clinical significance of IgG4 in sinonasal and skull base inflammatory pseudotumor

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Introduction

Inflammatory pseudotumor (IPT) in the sinonasal cavity and skull base region is benign non-neoplastic inflammatory process. However, IPT can mimic malignant tumor or infectious disease and there are difficulties in confirmation of diagnosis. The aim of study is to evaluate the clinical significance of immunoglobulin G4 (IgG4) in IPT in terms of steroid response and differential diagnosis with other skull base infiltrative lesions.

Methods

Medical records were reviewed retrospectively from 1998 to 2016. Subjects diagnosed with IPT by surgical biopsy were enrolled. IgG4 positivity was defined as IgG4/IgG ratio > 0.4. Additionally, IgG4/IgG ratio was calculated in eight skull base osteomyelitis (SBO) patients.

Results

Twenty-six IPT patients were included and the average age was 52.3 years, and 57.7% were male and 42.3% were female. Most lesions were involved in the sinuses (88.5%) and the incidence of extension beyond the sinuses itself was as follows: the cheek/hard palate/parapharynx (15.4%), orbit (61.5%), skull base (57.7%), and dura or brain (23.1%). All IPT cases revealed IgG4 + plasma cells and IgG4/IgG ratio over 0.4 was detected in 42.3% (11/26) of cases. In case of SBO, no patients had IgG4/IgG ratio exceed 0.4. Main treatment modality was systemic steroids (61.5%) and other modalities were used: surgery (3.8%), immunosuppressant (7.7%), radiotherapy (30.8%), or a combination of these modalities (15.4%). Steroid responses were not significantly different, but IgG4-positive group tended to have better response to steroid therapy.

Conclusions

IgG4-positive and IgG4-negative IPT patients revealed no differences in involvement sites, clinical course, and steroid responses. However, IgG4/IgG ratio and IgG4 + plasma cell count can provide a diagnostic clue for infiltrative skull base lesions such as IPT and a differential diagnosis of SBO.

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MEST) (2017R1A2B4006453). In addition, this work was supported by the Soonchunhyang University Research Fund.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan, Chungcheongnam-do, Republic of Korea

    Gwanghui Ryu

  2. Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, Republic of Korea

    Hyun-Jin Cho

  3. Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Kyung Eun Lee, Jung Joo Lee, Sang Duk Hong, Hyo Yeol Kim, Seung-Kyu Chung & Hun-Jong Dhong

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  1. Gwanghui Ryu
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Correspondence to Hun-Jong Dhong.

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Ryu, G., Cho, HJ., Lee, K.E. et al. Clinical significance of IgG4 in sinonasal and skull base inflammatory pseudotumor. Eur Arch Otorhinolaryngol 276, 2465–2473 (2019). https://doi.org/10.1007/s00405-019-05505-6

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  • DOI: https://doi.org/10.1007/s00405-019-05505-6

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