Immunohistochemistry for immunoglobulin G4 in the diagnosis of pemphigus

Heidarpour, Mitra; Rajabi, Parvin; Pour, Elnaz Babaei; Fayyazi, Emad

doi:10.4103/ijd.ijd_87_18

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Preparation of frozen biopsies depends on a cryostat as a trained technician; in addition, a fluorescent microscope is necessary to analyze the slides. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

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Immunohistochemical Evaluation of C4d and C3d Markers in Bullous Pemphigoid as a Substitute for Direct Immunofluorescence Technique

Oryani,

Tayebi-Meybodi,

Nahidi

et al. 2023

Indian Journal of Dermatology

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Background: There are several methods for the diagnosis of autoimmune bullous disease. Direct immunofluorescent (DIF) testing is an important diagnostic method in the diagnosis of immunobullous disease but requires skilled pathologist, fresh tissue and well-equipped laboratory to perform the procedure. The immunohistochemistry analysis of C4d and C3d is easily compared with other methods. This study was conducted to assess the value of immunohistochemistry (IHC) analysis for expressions of C3d and C4d in the diagnosis of bullous pemphigoid (BP). Aims and Objectives: This study was conducted to assess the value of immunohistochemistry (IHC) analysis for expressions of C3d and C4d in the diagnosis of bullous pemphigoid (BP). Materials and Method: We applied C4d and C3d immunohistochemistry on formalin-fixed, paraffin-embedded tissue on 30 cases of bullous pemphigoid that was confirmed by direct immunofluorescence (DIF) evaluation as well as 16 cases in control group (12 cases of herpetiform dermatitis, 3 cases of linear IgA dermatosis and 3 cases of bullous lichen planus). Results: Mean and SD of age were 68.13 ± 14.00, female to male ratio was 1:3. In cases where both C3d and C4d staining were positive, the intensity of C3d staining was higher than C4d. Twenty-two cases showed C4d-positive staining in IHC study, such that in seven cases focal staining and in 15 cases diffuse staining were observed. Also 26 cases showed C3d-positive staining in IHC study such that in four cases focal staining and in 22 cases diffuse staining were observed. In cases with C3d-positive staining, there were 21 cases of deposition only on the bullous floor, one case on the bullous roof and four cases on the bullous roof and floor. In cases with C4d-positive staining, there were 17 cases of deposition on the bullous floor, two cases only on the bullous roof and three cases on the roof and floor. All control cases were negative for C3d and C4d staining in the dermoepidermal junction. For C3d immunohistochemical staining, sensitivity, specificity, positive predictive value and negative predictive value were 86.66%, 100%, 100% and 80%, respectively, and for C4d immunohistochemical staining, respectively, were 73.3%, 100%, 100% and 66.66%. Conclusion: The immunohistochemical specificity of C4d and C3d on tissue blocks is the same as that of direct immunofluorescence test on fresh tissue, but it is less sensitive, so positive results for C3d and C4d immunohistochemical staining on paraffin blocks can be used to confirm the diagnosis of bullous pemphigoid.

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“…Preparation of frozen biopsies depends on a cryostat as a trained technician; in addition, a fluorescent microscope is necessary to analyze the slides. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

“…New chromogens and antibodies, computerised analysis and automated processing increased sensitivity and specificity of IHC. [ 4 ] This method is widely used as a reliable method in diagnostic pathology. [ 2 3 ]…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical Evaluation of C4d and C3d Markers in Bullous Pemphigoid as a Substitute for Direct Immunofluorescence Technique

Oryani,

Tayebi-Meybodi,

Nahidi

et al. 2023

Indian Journal of Dermatology

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Immunohistochemistry for Immunoglobulin G4 on Paraffin Sections as a Diagnostic Test for Pemphigus

Abadjieva,

Genova,

Pencheva

et al. 2024

The American Journal of Dermatopathology

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Pemphigus is a group of autoimmune bullous diseases mediated by autoantibodies most often of the immunoglobulin G class, subclasses immunoglobulin G1, and immunoglobulin G4 (IgG4), directed against desmosomal adhesion proteins of keratinocytes. This study aimed to evaluate IgG4 immunoreactivity on paraffin sections using immunohistochemistry in patients with pemphigus as a diagnostic test. Fifty formalin-fixed paraffin-embedded specimens from patients with pemphigus were selected. Fifty formalin-fixed paraffin-embedded specimens from patients with bullous diseases other than pemphigus were used as controls. Biopsies were performed on active lesions in newly diagnosed patients. Immunohistochemistry for IgG4 was performed on paraffin sections with an anti-immunoglobulin G4 antibody. Positivity was defined as distinctive, uninterrupted immunoreactivity localized to the intercellular junctions of keratinocytes. A finding that did not meet these criteria was defined as negative. Forty-three (86.0%) of the examined patients had pemphigus vulgaris and 7 (14%) had pemphigus foliaceus. Forty-nine (98.0%) specimens from patients with pemphigus were immunoreactive for IgG4, 1 (2%) upper back biopsy from the patient with oral pemphigus showed negative immunoreactivity for IgG4. Negative immunoreactivity was found in 45 (90%) controls. Five (10%) controls with bullous pemphigoid showed immunoreactivity for IgG4. Sensitivity of the method was established to be 98% and specificity 90%. Immunohistochemical examination for IgG4 for the diagnosis of pemphigus can be applied when direct immunofluorescence examination is unavailable. The advantage of this method is that it does not require special equipment and the histology slides are permanent.

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Potential Pitfalls of IgG4 Immunohistochemical Staining on Lesional Tissue in Cutaneous Acantholytic Disorders

Stephan,

2024

Dermatopathology

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The diagnostic utility of immunohistochemistry on paraffin-embedded sections in bullous disorders is useful when frozen tissue is not available. In pemphigus vulgaris and pemphigus foliaceus, an intercellular lace-like staining pattern of IgG4 on lesional tissue by immunohistochemistry has been described, with a comparable sensitivity and specificity to direct immunofluorescence on perilesional tissue. This study aimed to evaluate the staining pattern of IgG4 in non-immunobullous disorders to highlight the potential pitfalls when using this stain. In this study, we conducted a retrospective review of our institution’s database of non-immunobullous disorders where immunohistochemistry of IgG4 was performed to rule out pemphigus. We identified 27 cases where IgG4 immunohistochemistry was performed and observed intercellular IgG4 staining in some cases of Grover disease, bullous impetigo, irritated dermal hypersensitivity reaction, acantholytic actinic keratosis, and graft versus host disease. Our results indicate that the interpretation of IgG4 staining by immunohistochemistry in cutaneous acantholytic disorders should be approached with caution. Confirmation on cryosections with direct immunofluorescence study results is important in these settings.

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Immunohistochemistry for immunoglobulin G4 in the diagnosis of pemphigus

Cited by 3 publications

References 9 publications

Immunohistochemical Evaluation of C4d and C3d Markers in Bullous Pemphigoid as a Substitute for Direct Immunofluorescence Technique

Immunohistochemical Evaluation of C4d and C3d Markers in Bullous Pemphigoid as a Substitute for Direct Immunofluorescence Technique

Immunohistochemistry for Immunoglobulin G4 on Paraffin Sections as a Diagnostic Test for Pemphigus

Potential Pitfalls of IgG4 Immunohistochemical Staining on Lesional Tissue in Cutaneous Acantholytic Disorders

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