免疫治疗对变应性鼻炎患者鼻分泌物中螨变应原特异性IgG1和IgG4抗体水平的影响

目的检测变应性鼻炎患者和健康人群鼻分泌物中螨变应原特异性IgG1和IgG4抗体水平，以了解变应原特异性IgG亚型抗体在人群鼻分泌物中的分布和免疫治疗对抗体浓度的影响。方法利用负压吸引法收集健康人群、变应性鼻炎未治疗组和免疫治疗组患者的鼻分泌物，采用间接非竞争生物素一链亲和素酶联免疫法检测鼻分泌物中粗制螨变应原、螨纯化变应原Der f Ⅰ和Der f Ⅱ各变应原特异性IgG1和IgG4亚型抗体浓度。结果变应性鼻炎患者鼻分泌物中螨粗制变应原特异性IgG1和IgG4抗体浓度均高于健康人(Z=-3．623、-3．061，P均＜0．01)；免疫治疗组患者IgG1和IgG4抗体浓度均高于非治疗组(Z=-2．453、-3．408，P均＜0．01)。免疫治疗组变应性鼻炎患者鼻分泌物中螨纯化变应原DerfI特异性Igc,4抗体水平较健康人群增高(Z=-3．518，P＜0．01)；而免疫治疗组DerfⅡ特异性IgG1和IgG4抗体水平均高于健康人(Z=-2．366、-2．936，P均＜0．01)和未治疗组(Z：-2．366、-2．937，P均＜0．01)。IgG1和IgG4亚群抗体中，螨粗制抗原、Der f Ⅰ和Der f Ⅱ特异性抗体水平相互间具有相关性；三类变应原特异性IgG1和IgG4抗体间存在相关性；免疫治疗组患者鼻分泌物中螨粗制变应原IgG1和IgC4抗体与血清中特异性IgE抗体间具有相关性。结论健康人群和变应性鼻炎患者均具有对其环境变应原产生特异性IgG1和IgG4抗体的能力，而变应性鼻炎患者具有更高的反应性，能产生高于健康人的特异性IgG亚型抗体，而变应原特异性免疫治疗能显著增加鼻分泌物中IgG1和IgC4抗体的水平。鼻分泌物中IgG1和IgG4抗体的增加可能是免疫治疗有效的机制之一。     

儿童变应性鼻炎免疫治疗的临床疗效及免疫学机制研究

目的 评价标准化尘螨变应原疫苗治疗儿童变应性鼻炎的临床疗效并初步探索其免疫学机制.方法螨过敏变应性鼻炎儿童64例,随机分为免疫治疗组(32例)和药物治疗组(32例).通过症状评分和药物评分评价临床疗效,并检测治疗前后血清中总IgE、螨特异性IgE、特异性IgG4的水平.结果 经过1年的治疗,免疫治疗组患儿的症状评分(4[3;6]分)和药物评分(0.35[0.30;0.43]分)较治疗前(分别为10[9;11]分、0.76[0.61;0.90]分)均明显减少且差异有统计学意义(Z值分别为-4.80、-4.74,P值均<0.01),与药物治疗组(分别为7[5;9]分、0.72[0.60;0.92]分)相比差异亦有统计学意义(U值分别为155.00、139.50,P值均<0.01).总IgE和螨特异性IgE水平未见明显改变,但免疫治疗组患儿血清中螨特异性IgG4的水平明显升高(U=6.00,P<0.01).结论 标准化螨变应原免疫治疗能够有效改善变应性鼻炎患儿的症状,减少药物使用,变应原特异性IgG4的增高可作为预测免疫治疗疗效的免疫学参考指标.

Abstract：

Objective To evaluate the efficacy and immunological changes of children receiving subcutaneous immunotherapy with Dermatophagoides pteronyssinus. Methods Sixty-four children with allergic rhinitis to Dermawphagoides pteronyssinus (Der p) were randomly allocated to receive either specificimmunotherapy (n = 32) or medical treatment (n = 32 ). Symptom and medication scores were assessed toevaluate the clinical efficacy in the baseline and after one year treatment. Total IgE, Der p-specific IgE, and specific IgG4 were measured. Results Immunotherapy reduced the symptom ( the scores reduced from 10[9;11] to4[3;6]) and medication score (the scores reduced from 0.76[0.61; 0.90] to 0.35[0.30;0. 43] ) in children with arlergic rhinitis significantly ( Z value were - 4.80 and - 4.74, respectively, each P＜0.01 ). There was a significant difference in symptom and medication scores between both groups after one year treatment ( U value were 155. 00 and 139.50, respectively, each P ＜ 0.01 ). There were no differences in levels of serum total IgE, specific IgE before and after one year treatment, but the level of serum specific IgG4 increased significantly after one year treatment. Conclusions Immunotherapy with standardized extract is efficacious to treat children sensitive to Der p, allergen-specific IgG4 is significant as immunological marker to predict efficacy of immunotherapy.     

鼻声反射对特异性变应原皮下免疫治疗儿童变应性鼻炎的疗效评估

摘要：目的探讨鼻声反射测量评估特异性变应原皮下免疫治疗变应性鼻炎的疗效。方法对接受阿罗格（螨变应原注射液）皮下注射脱敏治疗的65例变应性鼻炎患儿进行研究,其中男40例,女25例;年龄5～13岁,平均年龄（7.1±2.2）岁。所有患儿均对屋尘螨和粉尘螨过敏,完成1年的特异性皮下免疫治疗。治疗前和治疗后1年分别进行症状评分和鼻声反射测量,分析治疗前后鼻腔容积（NV）及鼻腔最小横截面积（MCA）的变化,评估特异性变应原皮下免疫治疗的疗效。结果65例变应性鼻炎患儿特异性变应原皮下免疫治疗1年后症状评分明显改善,治疗1年后鼻腔容积及鼻腔最小横截面积与治疗前相比显著增加。结论鼻声反射测量是客观反映鼻腔通气状况的指标。鼻声反射测定值与患者主观感受具有高度一致性,对鼻腔通气功能的临床评估有应用价值。特异性变应原皮下免疫治疗变应性鼻炎疗效确切,用鼻声反射测量来评估是客观准确的。     

标准化尘螨变应原疫苗治疗应性鼻炎一年的疗效和安全性研究

目的 评价标准化尘螨变应原免疫治疗变应性鼻炎的疗效及安全性.方法 60例螨过敏变应性鼻炎患者随机分为免疫治疗组30例和药物治疗组30例.通过症状评分、药物评分、鼻炎相关生活质量评分和不良反应分级评价免疫治疗的疗效和安全性.结果 经过1年治疗后,免疫治疗组症状评分和药物评分较治疗前均明显减少(P＜0.01),与药物治疗组相比亦有显著性差异(P＜0.01).同时,免疫治疗组患者的鼻炎相关生活质量明显改善.所有免疫治疗病例未出现严重不良反应.结论 标准化螨变应原免疫治疗可安全有效地治疗变应性鼻炎.     

变应性鼻炎和哮喘患者变应原类型及免疫治疗疗效的比较

目的 比较单纯性变应性鼻炎患者和哮喘患者变应原阳性率及变应原免疫治疗情况,分析机体对变应原反应程度与疾病的发生、发展及免疫治疗的关系.方法 对100例单纯性变应性鼻炎和100例哮喘患者行皮肤点刺试验,根据变应原类型从中挑选各30名符合混合螨免疫治疗条件者进行变应原免疫治疗.标准化皮肤点刺液和脱敏制剂均由阿罗格公司提供.结果 单纯变应性鼻炎组的主要吸入性变应原和摄入性变应原阳性率均显著低于哮喘组,且主要吸入性变应原屋尘螨和粉尘螨的强阳性率亦明显低于哮喘组.变应原免疫治疗则无显著差异.结论 机体对变应原的反应程度与疾病的发生、发展可能存在一定的关系.对变应性鼻炎的早期干预是必要的.     

变应性鼻炎屋尘螨变应原皮下免疫治疗的远期疗效研究

目的 评价皮下注射标准化屋尘螨变应原疫苗治疗变应性鼻炎的远期疗效.方法 将92例单一屋尘螨过敏的变应性鼻炎患者随机分为免疫治疗组(46例)和药物治疗组(46例).通过症状评分、药物评分和屋尘螨特异性皮肤反应指数评价临床疗效,同时检测血清中屋尘螨特异性IgE、特异性IgG4的水平.结果 经过3年治疗后,免疫治疗组患者的症状评分、药物评分(中位数[25分位数;75分位数])和屋尘螨特异性皮肤反应指数(均值±标准差)分别为3.32 [2.49;5.12]分、0.31[0.28;0.45]分、1.34 ±0.29,较治疗前的9.20[7.50;11.13]分、0.72[0.47;0.83]分、1.71±0.53,均明显减少,差异有统计学意义(检验值分别为-5.13、-5.78、6.37,P值均＜0.05),以上3项指标免疫治疗组与药物治疗组相比差异亦有统计学意义(P值均＜0.05).血清屋尘螨特异性IgE水平治疗前为16.32[4.34;38.65] kU/L,免疫治疗3年后为15.85[4.93;46.27] kU/L,差异无统计学意义(Z=-0.84,P＞0.05);免疫治疗组患者血清中螨特异性IgG4治疗后为8387[ 7732;16 634]AU/L,较治疗前的486[ 319;1439] AU/L明显升高,差异有统计学意义(Z=-2.81,P＜0.05).7.5％(3/40)的免疫治疗组患者在3年后出现了哮喘症状,明显低于药物治疗组哮喘症状的发生率(27.8％),差异有统计学意义(x2=5.50,P＜0.05).15.0％ (6/40)的免疫治疗组患者在3年后出现了新的过敏原反应,明显低于药物治疗组(47.2％),差异有统计学意义(x2=9.32,P＜0.05).结论 对于变应性鼻炎患者而言,标准化屋尘螨变应原免疫治疗能够有效改善症状、减少药物使用及降低特异性皮肤反应,升高血清中特异性IgG4水平,有效减少哮喘和新的过敏反应的发生.     

儿童变应性鼻炎舌下免疫治疗的临床疗效及免疫因子IL-10水平检测

目的评价标准化尘螨变应原疫苗舌下免疫治疗儿童变应性鼻炎的临床疗效并初步探讨其免疫学机制。方法尘螨过敏的变应性鼻炎儿童60例,随机分为免疫治疗组(31例)和药物治疗组(29例)。通过症状评分和药物评分评价临床疗效,并检测治疗前后血清中总LgE、螨特异性LgE、免疫因子IL-10的水平。结果经过1年的治疗,免疫治疗组患儿的症状评分[(4±0.50)分]和药物评分[(0.35±0.04)分]较治疗前症状评分[(10±1.0)分]及药物评分[(0.76±0.08)分]均明显减少且差异具有统计学意义(Z值分别为-4.65、-4.43,P值均<0.01);与药物治疗组症状评分[(7±0.5 0)分]和药物评分[(0.7 2±0.0 5)分]比较,差异具有统计学意义(U值分别为1 4 3.0 0、1 3 8.5 0,P值均<0.0 1)。总LgE无明显变化,螨特异性LgE水平明显下降,免疫治疗组患儿血清中IL-1 0的水平明显升高(U=5.00,P<0.01)。结论标准化尘螨变应原疫苗舌下免疫治疗能够有效改善变应性鼻炎患儿的症状,减少药物使用,细胞因子IL-10的增高可作为预测舌下免疫治疗疗效的免疫学参考指标。     

小儿变应性鼻炎症状与尘螨特异性IgE及家居环境尘螨变应原含量相关性分析

目的　探究学龄前儿童变应性鼻炎症状与家居环境尘螨及尘螨特异性IgE（specific IgE,sIgE）相关性,为小儿过敏性疾病防治工作提供理论依据。方法　出生于芜 湖市第二人民医院,3～4周岁时,对患有变应性鼻炎儿童进行家庭内随访,评估患儿变应性鼻炎症状积分,采集患儿家居环境灰尘样本,应用酶联免疫吸附法测定尘样中屋尘螨第1组分变应原（Der p1）和粉尘螨第1组分变应原（Der f1）含量,并对患儿进行血清尘螨sIgE水平检测。结果　对采集的64份尘螨样本进行相关性分析,小儿变应性鼻炎症状与屋尘螨sIgE和粉尘螨sIgE之间有正相关性（P <0.05）;小儿变应性鼻炎症状与Der p1 和Der f1 之间有正相关性（P <0.05）。患儿居室内Der p1 和Der f1 暴露水平与屋尘螨sIgE及粉尘螨sIgE相互之间没有统计学意义上的相关性（P >0.05）。结论　小儿变应性鼻炎症状与家居环境尘螨含量及尘螨sIgE呈正相关,给临床科研提供了一个研究方向,提示可通过检测sIgE水平初步预测变应性鼻炎症状严重性,通过加强尘螨健康教育及降低居室环境尘螨含量来防治过敏性疾病和改善生活质量。     

舌下含服和皮下注射免疫治疗儿童变应性鼻炎的临床疗效观察

目的比较舌下免疫治疗（sublingual immunotherapy,SLIT）、皮下免疫治疗（subcutaneous immunotherapy,SCIT）及单纯药物治疗儿童变应性鼻炎（allergic rhinitis,AR）的临床疗效并初步探索其免疫机制。方法收集能坚持治疗并定期随访的螨过敏变应性鼻炎儿童90例,按数字随机法分成3组,SLIT组（30例）、SCIT组（30例）和单纯药物治疗组（30例）。通过症状评分、药物评分和视觉模拟评分量表（VAS）评价各组治疗后临床疗效,并检测治疗前后血清中总IgE、螨特异性IgE、特异性IgG4的含量。结果经过2年的治疗,SLIT组和SCIT组患儿的症状评分、药物评分及VAS较治疗前均明显减少且差异具有统计学意义（P均〈0.01）,与药物治疗组相比差异具有统计学意义（P均〈0.01）。两组免疫治疗组总IgE和螨特异性IgE水平未见明显改变,但血清中螨特异性IgG4水平明显升高（P〈0.01）。结论相对于单纯药物治疗儿童AR,采用SLIT和SCIT治疗能够有效改善患儿的症状,减少药物使用,变应原特异性IgG4的增高可作为预测免疫治疗疗效的参考指标。     

内蒙古草原环境下鼻炎患者尘螨暴露与致敏的研究

目的 探讨内蒙古草原环境下鼻炎患者居室尘螨变应原暴露水平与致敏的关系,评估皮肤点刺试验(skin prick test,SPT)和血清特异性IgE( specific IgE,sIgE)两种检测方法诊断尘螨致敏的一致性.方法 集中招募内蒙古锡林浩特市具有鼻炎症状的患者314例,接受病史询问、前鼻镜检查、变应原体内检测(SPT法)和体外检测(sIgE法).采集患者卧室床垫尘埃,酶联免疫吸附(enzyme linked immunosorbent assay,ELISA)试验检测屋尘螨(Dermatophagoides pteronyssinus,Der p)和粉尘螨(Dermatophagoides farinae,Der f)主要变应原Der p 1和Der f1的含量.以SPSS 17.0软件进行t检验、x2检验等.结果314例鼻炎患者中,变应原检测结果为:Der p SPT阳性率5.7％,sIgE阳性率9.2％;DerfSPT阳性率22.0％,sIgE阳性率7.6％,均低于花粉的阳性率.花粉变应原中以艾蒿阳性率最高,SPT为51.9％,sIgE为47.1％.以尘螨变应原SPT作为判定致敏与否的“金标准”,sIgE检测Der p和Der f的阳性似然比分别为4.27和10.64,Kappa值分别为0.20和0.35.共计276例鼻炎患者进行了床垫尘埃检测,Der p 1阳性2例(0.7％),Der f1阳性4例(1.4％).Der p 1暴露水平与SPT阳性呈正相关(rs =0.156,P=0.01),但与sIgE阳性的相关性无统计学意义(rs=0.116,P=0.055);Der f1暴露水平与SPT和sIgE阳性均无明显相关性(rs=0.05,P=0.931;rs=0.07,P=0.245).结论 内蒙古草原环境下尘螨暴露水平很低,Der p和Der f不是变应性鼻炎患者的主要致敏原,尘螨的暴露与致敏之间也非简单的剂量-反应关系.在此特殊环境中,尘螨变应原SPT与sIgE检测结果的一致性强度较低,故建议采取体内和体外检测手段相结合进行临床诊断.     

A solely ear-involved IgG4-related sclerosing disease with two-years following-up

IntroductionImmunoglobulin G4-related sclerosing disease (IgG4-RSD) is a chronic fibro-inflammatory disease involving systemic multi-organ lesions, such as the salivary and lacrimal glands, lymph nodes and pancreas. The diagnosis of this disease is reliant upon clinical manifestations, laboratory tests, histopathologic results and radiological data. Some studies have found that IgG4-RSD has otological manifestations, whereas there were few studies introducing the diagnosis, therapy and long-term follow-up results of solely otological IgG4-RSD.Case summaryHere, we report a case of IgG4-RSD involving the ear alone. A female presenting with otalgia and hearing loss underwent surgery, without hormone therapy. The pathological diagnosis was otological IgG4-RSD and no clinical or radiological signs of recurrence were observed at seven and twenty-four months follow-up.DiscussionThis case indicates that IgG4-RSD can invade the ear only, and that surgical therapy without hormone therapy is efficient for solely IgG4-RSD. Pathological results are crucial for diagnosis.     

IgG4相关性疾病4例报告并文献回顾

目的 探讨IgG4相关性疾病的临床表现、病理学特征及影像学表现。 方法 分析4例IgG4相关性疾病的临床特征、组织病理学及影像学改变,并查阅相关文献进行总结。 结果 本组4例的平均年龄为55岁,男女比例为3∶1。分别发生于颌下腺2例、眼眶1例、颜面部1例。临床表现无显著特异性,均呈无痛渐进性肿胀。病理学改变为淋巴组织及纤维组织增生,其内有较多浆细胞浸润(IgG4阳性浆细胞>50个/HPF,IgG4阳性浆细胞>IgG阳性浆细胞的40%)。影像学上表现为病变区炎性改变。 结论 IgG4相关性疾病是目前临床较为少见的疾病,发病机制尚不明确。需结合临床表现、血清学检测、病理学特征及影像学表现做出最终诊断,进而行及时准确的治疗。     

Increased number of IgG4-positive plasma cells in chronic rhinosinusitis

Conclusion: High levels of IgG4-positive plasma cells were observed in tissue samples from ～30% of patients with chronic rhinosinusitis who satisfied the comprehensive diagnostic criteria for IgG4-related disease. Detection of increased numbers of IgG4-positive plasma cells in the nasal cavity or paranasal sinuses might not be sufficient to make a diagnosis of IgG4-related rhinosinusitis, and a comprehensive evaluation is required.

Objectives: This study aimed to clarify the clinicopathological characteristics of IgG4-positive plasma cells in patients with chronic rhinosinusitis.

Method: This study examined nasal mucosal specimens from 35 patients and assigned them to high-IgG4 and low-IgG4 groups based on infiltration of IgG4-positive plasma cells. It compared the pathological characteristics of the two groups, including the presence of fibrosis, phlebitis, hyperplasia of the nasal glands and infiltration of inflammatory cells.

Results: No cases of chronic rhinosinusitis showed storiform fibrosis or obliterative phlebitis. The mean number of IgG4-positive plasma cells in samples from all patients was 29.8?±?40.3/high-power field. Eleven of the 35 cases (31.4%) were classified as high-IgG4. Hyperplasia of the nasal glands was observed significantly more frequently in the high-IgG4 group than in the low-IgG4 group (p?=?.03).     

IgG4-related disease with pseudotumor formation in the larynx

Mikulicz’s disease, an immunoglobulin G4-related disease (IgG4-RD) occurs frequently in the head and neck region but rarely in the larynx. We report a case of IgG4-RD with pseudotumor formation in the larynx. A 50-year-old man presented at our facility for a complete physical examination and diagnostic testing of a left arytenoid tumor. On examination, a large supraglottic mass was noted with signs of dyspnea. Movement disorder of the vocal fold was absent. The patient underwent surgery with general anesthesia to improve respiratory symptoms and a resected specimen was submitted for diagnosis. The pathology findings revealed lymph follicle formation, interstitial follicular fibrosis, angiogenesis, and inflammatory cell infiltration with plasmacytosis. Immunohistologic staining at high magnification revealed one hundred or more IgG4-positive plasma cells and fifty percent IgG4/IgG. In addition, obliterative phlebitis was observed. Medical history was positive for retroperitoneal fibrosis with serum IgG4 levels below the diagnostic criteria of IgG4-RD, but histological characteristics of IgG4-RD were met. The diagnosis of IgG4-RD was established, oral treatment with prednisolone (0.6 mg/kg/day) was initiated, and the tumor reduced in size. IgG4-RD may cause irreversible functional impairment. Early diagnosis and treatment are important in reducing the risk of permanent impairment of vocal fold mobility.     

Clinicopathological analysis of salivary gland tissue from patients with IgG4-related disease

Conclusion The diagnosis of immunoglobulin G4-related disease (IgG4-RD) should be based on the morphology of tissue biopsy, and this study recommends a submandibular gland (SMG) biopsy for accurate diagnosis and to exclude malignant disease. Objective To clarify which type of biopsy specimen (SMG or labial salivary gland [LSG]) should be taken from patients with IgG4-RD. Methods This study included 33 patients with IgG4-RD (21 women; 12 men) who were subjected to both SMG and LSG biopsies at Sapporo Medical University between 2011–2015. Tissues obtained from the SMG and LSG specimens were evaluated. Results All SMG specimens satisfied the diagnostic criteria for IgG4-RD, whereas 19 (57.6%) LSG specimens satisfied the diagnostic criteria for IgG4-RD. Histological evaluation showed fibrosis in all the SMG specimens and in eight LSG specimens (24.2%). Obliterative phlebitis was seen in nine SMG specimens (27.3%), but it was absent in all the LSG specimens.     

Warthin's tumor associated with IgG4-related disease

Immunoglobulin G4-related disease (IgG4-RD) is an inflammatory condition associated with elevated serum IgG4 levels and tissue infiltration by IgG4-expressing plasma cells. Several inflammatory conditions associated with IgG4-RD have been reported. Warthin's tumor is a benign parotid gland tumor consisting of oncocytic epithelial cells and lymphoid stroma containing lymphoid follicles with reactive germinal centers. This is the first report describing a case of Warthin's tumor with possible involvement of IgG4-RD. The patient was a 71-year-old man presenting with swollen right parotid and bilateral submandibular glands. He had a history of a Warthin's tumor of the left parotid gland, autoimmune pancreatitis, and an inflammatory abdominal aortic aneurysm. Laboratory tests revealed a high serum IgG4 level. Histological examination of the resected parotid gland showed a Warthin's tumor and a nodule showing severe lymphocytic infiltration containing many IgG4-positive plasma cells. This case shows the possible involvement of Warthin's tumor with IgG4-RD.     

The clinical role of specific IgE and IgG4 antibodies in patients having immunotherapy for seasonal allergic rhinitis

This study was designed to investigate the clinical role of specific IgG4 and IgE responses in patients during immunotherapy for seasonal allergy. The study included 109 patients with seasonal allergic rhinitis due to Japanese cedar pollens. They were divided into the control group and the immunotherapy group. Serum samples were obtained at the start of immunotherapy, before the pollen season and during the season, to determine serum specific IgE and IgG4. In the control group specific IgE was significantly increased, but specific IgG4 was not changed during the pollen season. In the immunotherapy group specific IgE was not significantly increased, but specific IgG4 was significantly increased during the season. In the patients having immunotherapy for 2 years or less, the seasonal increase in specific IgG4 related to the magnitude of the clinical effect. In the patients having immunotherapy for 3 years or more, the seasonal increase in specific IgE related to the magnitude of the clinical effect. In conclusion, the specific IgG4 response and specific IgE response during the pollen season make a significant contribution to the clinical effect of immunotherapy. However, modulation of specific IgE and IgG4 responses out of the pollen season was unlikely to be an important phenomenon related to the clinical effect of immunotherapy.     

Mucosa-associated lymphoid tissue lymphoma of the thyroid with abundant IgG4-positive plasma cells

A case of thyroidal mucosa-associated lymphoid tissue (MALT) lymphoma mimicking IgG4-related disease is described. A 54-year-old male presented with acute swelling of the anterior neck. Anaplastic thyroid carcinoma (ATC), malignant lymphoma (ML), or acute deterioration of Hashimoto's thyroiditis were initially suspected, and an emergent tracheostomy was required for progressive airway obstruction; a simultaneous biopsy from the thyroid tissue was performed. Histopathologically, the lesion consisted of sclerotic fibrosis and diffuse and dense infiltration by small lymphoid cells without atypia and plasma cells, many of which were IgG4-positive. Blood examination also revealed high serum IgG4 levels. Riedel's thyroiditis was suspected. However, despite medical treatments, a firm swelling of the thyroid still remained. In an in situ hybridization study, IgG4-negative plasma cells showed immunoglobulin light-chain restriction (κ-monotype), and immunoglobulin heavy (IgH) chain gene monoclonal re-arrangement was detected by polymerase chain reaction. The lesion was finally diagnosed as MALT lymphoma. When IgG4-related disease is suspected, it is important to thoroughly exclude other possibilities.