Commentary on IgG4-related sialadenitis: Mikulicz's disease, Küttner's tumour, and eponymy
Résumé
The paper by Laco et al. (HISTOP-04-10-0251.R2) is the first description of IgG4-related sialadenitis from Central Europe, and it seems likely that the disease will be found worldwide. Although the use of the terms Küttner's tumour and Mikulicz's disease as eponyms for IgG4-related sialadenitis is widespread, it is confusing and better avoided. It appears prudent to immunostain in order to estimate the number and fraction of plasma cells with IgG4 in cases of sialadenitis that show severe fibrosis and atrophy and a heavy lymphoid infiltrate in order that cases of IgG4-related sialadenitis may be confidently diagnosed. Laco et al. found that a lower limit of 50 IgG4-positive plasma cells per 1 high-power field produces a sensitivity and specificity of 100%, and that the ratio of IgG4-positive plasma cells to IgG-positive plasma cells is at least 0.40 in cases of IgG4-related sialadenitis and no more than 0.26 in control cases.
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