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Case report
IgG4-related lymphadenopathy masquerading as Hodgkin lymphoma: lessons from a pathologist’s desk
  1. Sree Rekha Jinkala1,
  2. Bheemanathi Hanuman Srinivas1,
  3. Puthenpurackal Sivanpillai Priyamvada2 and
  4. Debdatta Basu1
  1. 1 Pathology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
  2. 2 Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
  1. Correspondence to Dr Bheemanathi Hanuman Srinivas, srinivas.bh08{at}gmail.com

Abstract

IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder affecting multiple organ systems. The awareness of this disease has tremendously increased over the last decade leading to effective treatment and decreased morbidity to the patients. Histopathology plays an important role in the diagnosis of IgG4-RD, and definite histologic criteria are proposed in clinically suspected patients. We report a patient with multiple organ system involvements of the salivary gland, lymph node and kidney. IgG4-related lymphadenopathy (IgG4-RL) in this patient was misdiagnosed as nodular lymphocyte predominant Hodgkin’s lymphoma (NLPHL). Refractoriness to treatment for NLPHL and subsequent manifestations of renal involvement lead us to the correct diagnosis of this potentially treatable condition. IgG4-RL can mimic reactive proliferation as well as lymphomas. We report the clinical presentation and discuss the problems faced by pathologists in diagnosing IgG4-RL. We believe that awareness of this rare presentation will enhance the knowledge in diagnosing IgG4-RD.

  • malignant and benign haematology
  • pathology
  • proteinurea
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Footnotes

  • Contributors SRJ and BHS are pathologists, diagnosed lymph node biopsy and kidney biopsy. PSP is the nephrologist treating the patient. SRJ drafted the manuscript. BHS, PSP and DB reviewed the manuscript and provided expert opinion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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