Moreira RK, Revetta F, Koehler E, Washington MK. Diagnostic utility of IgG and IgM immunohistochemistry in autoimmune liver disease. World J Gastroenterol 2010; 16(4): 453-457 [PMID: 20101770 DOI: 10.3748/wjg.v16.i4.453]
Corresponding Author of This Article
Roger Klein Moreira, MD, Department of Pathology, Columbia University College of Physicians & Surgeons, 630 W168th Street VC14-238B, New York, NY 10032, United States. rkm2124@columbia.edu
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Brief Article
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World J Gastroenterol. Jan 28, 2010; 16(4): 453-457 Published online Jan 28, 2010. doi: 10.3748/wjg.v16.i4.453
Diagnostic utility of IgG and IgM immunohistochemistry in autoimmune liver disease
Roger Klein Moreira, Frank Revetta, Elizabeth Koehler, Mary Kay Washington
Roger Klein Moreira, Department of Pathology, Columbia University College of Physicians & Surgeons, New York, NY 10038, United States
Elizabeth Koehler, Department of Biostatistics, Vanderbilt University, Nashville, TN 37232, United States
Frank Revetta, Mary Kay Washington, Department of Pathology, Vanderbilt University, Nashville, TN 37232, United States
Author contributions: Moreira RK and Washington MK designed the study, selected patients, performed histopathologic and immunohistochemical analysis of slides, and wrote the manuscript; Koehler E was responsible for the statistical analysis of our data; Revetta F provided immunohistochemistry technical support and performed all immunohistochemistry stains used in this study.
Supported by Vanderbilt University Medical Center’s Digestive Disease Research Center, NIH Grant P30DK058404
Correspondence to: Roger Klein Moreira, MD, Department of Pathology, Columbia University College of Physicians & Surgeons, 630 W168th Street VC14-238B, New York, NY 10032, United States. rkm2124@columbia.edu
Telephone: +1-212-3429994 Fax: +1-212-3052301
Received: September 24, 2009 Revised: November 8, 2009 Accepted: November 15, 2009 Published online: January 28, 2010
Abstract
AIM: To assess the role of IgM and IgG immunohistochemistry (IHC) in the evaluation of autoimmune liver conditions - autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC).
METHODS: Forty one biopsies from untreated patients diagnosed with autoimmune liver disease (AIH, n = 20; PBC, n = 13; PSC, n = 8) and fourteen biopsies of patients with chronic hepatitis C were selected. IgM and IgG-positive plasma cells were counted in each sample.
RESULTS: A predominance of IgG-positive plasma cells was seen in AIH (90% of cases), PSC (75% of cases), and chronic hepatitis C (100% of cases), while IgM-positive plasma cells predominated in PBC (92.8% of cases). The IgM /IgG ratio (< 1 or ≥ 1) accurately distinguished PBC from AIH in 90.9% of cases (sensitivity = 92.3%, specificity = 90%), and PBC from either AIH or PSC in 87.8% of cases (sensitivity = 92.3%, specificity = 85.7%).
CONCLUSION: Plasmacytic infiltrates expressing predominantly IgM are characteristic of PBC, while other forms of liver disease analyzed in this study, including AIH, typically show an IgG-predominant plasma cell infiltrate. Our data indicate that IgM and IgG IHC may be a useful tool when PBC is a diagnostic consideration.
