Localized lymphoid hyperplasia with prominent IgG4-positive plasma cells in the inferior turbinate mimicking IgG4-related disease
4 affiliations
- 1Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital
- 2Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine
- 3Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital
- 4Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital
Abstract
Objectives: Localized lymphoid masses of the inferior turbinate with prominent IgG4-positive plasma cell infiltration are occasionally encountered in clinical practice, yet their nature and relationship to IgG4-related disease (IgG4-RD) remain uncertain. This study aimed to characterize the clinical, histopathological, and therapeutic features of these lesions.
Methods: We retrospectively reviewed patients presenting with localized submucosal masses of the inferior turbinate identified on nasal endoscopy at Seoul National University Hospital between January 2020 and May 2023. Biopsies were performed in cases with mucosal disruption, including crusting or bleeding. Classification of IgG4-RD was based on the 2019 American College of Rheumatology/European League Against Rheumatism criteria. The 2011 Comprehensive diagnosis criteria were applied to the patients with available biopsies.
Results: Of 14,103 patients undergoing nasal endoscopy, 41 (0.3%) demonstrated localized inferior turbinate submucosal lesions. Eighteen patients underwent biopsy, all of which revealed dense lymphoplasmacytic infiltration with variable IgG4-positive plasma cell counts. An IgG4+/IgG+ plasma cell ratio exceeding 40% was observed in 10 cases (55.6%). However, characteristic histopathological features of IgG4-RD, including storiform fibrosis and obliterative phlebitis, were absent. Only two patients fulfilled the 2019 classification criteria for IgG4-RD, both of whom had extra-nasal involvement. According to the 2011 Comprehensive diagnosis criteria, 2 patients were classified as definite IgG4-RD. Spontaneous improvement during observation occurred in a minority of patients. Surgical treatment resulted in durable symptom control with minimal recurrence, whereas corticosteroid therapy showed variable effectiveness.
Conclusions: Localized IgG4-rich lymphoid hyperplasia of the inferior turbinate may represent a distinct benign inflammatory lesion, mimicking a sinonasal manifestation of IgG4-RD. Further studies are required to clarify its pathophysiology, optimal management, and long-term outcomes.
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BibTeX
@article{han2026localized,
title = {{Localized lymphoid hyperplasia with prominent IgG4-positive plasma cells in the inferior turbinate mimicking IgG4-related disease}},
author = {Doo Hee Han and Ji In Jung and Ju Yeon Kim and Jiwon Koh and Jun Won Park and Eun Bong Lee and Jin Kyun Park},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1898657},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1898657/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Localized lymphoid hyperplasia with prominent IgG4-positive plasma cells in the inferior turbinate mimicking IgG4-related disease
AU - Doo Hee Han
AU - Ji In Jung
AU - Ju Yeon Kim
AU - Jiwon Koh
AU - Jun Won Park
AU - Eun Bong Lee
AU - Jin Kyun Park
PY - 2026
DA - 2026/10/14
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1898657
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1898657/full
AB - Objectives: Localized lymphoid masses of the inferior turbinate with prominent IgG4-positive plasma cell infiltration are occasionally encountered in clinical practice, yet their nature and relationship to IgG4-related disease (IgG4-RD) remain uncertain. This study aimed to characterize the clinical, histopathological, and therapeutic features of these lesions. Methods: We retrospectively reviewed patients presenting with localized submucosal masses of the inferior turbinate identified on nasal endoscopy at Seoul National University Hospital between January 2020 and May 2023. Biopsies were performed in cases with mucosal disruption, including crusting or bleeding. Classification of IgG4-RD was based on the 2019 American College of Rheumatology/European League Against Rheumatism criteria. The 2011 Comprehensive diagnosis criteria were applied to the patients with available biopsies. Results: Of 14,103 patients undergoing nasal endoscopy, 41 (0.3%) demonstrated localized inferior turbinate submucosal lesions. Eighteen patients underwent biopsy, all of which revealed dense lymphoplasmacytic infiltration with variable IgG4-positive plasma cell counts. An IgG4+/IgG+ plasma cell ratio exceeding 40% was observed in 10 cases (55.6%). However, characteristic histopathological features of IgG4-RD, including storiform fibrosis and obliterative phlebitis, were absent. Only two patients fulfilled the 2019 classification criteria for IgG4-RD, both of whom had extra-nasal involvement. According to the 2011 Comprehensive diagnosis criteria, 2 patients were classified as definite IgG4-RD. Spontaneous improvement during observation occurred in a minority of patients. Surgical treatment resulted in durable symptom control with minimal recurrence, whereas corticosteroid therapy showed variable effectiveness. Conclusions: Localized IgG4-rich lymphoid hyperplasia of the inferior turbinate may represent a distinct benign inflammatory lesion, mimicking a sinonasal manifestation of IgG4-RD. Further studies are required to clarify its pathophysiology, optimal management, and long-term outcomes.
SN - 1664-3224
ER -