BACKGROUND Immunoglobin G4(IgG4)-related hypophysitis(IgG4-RH)is a rare form of IgG4-related disease(IgG4-RD),which often manifests as a single organ disease and is easily misdiagnosed as a pituitary tumor clinically ...BACKGROUND Immunoglobin G4(IgG4)-related hypophysitis(IgG4-RH)is a rare form of IgG4-related disease(IgG4-RD),which often manifests as a single organ disease and is easily misdiagnosed as a pituitary tumor clinically and by imaging.There are few reports of imaging findings of IgG4-RH.Therefore,we describe a case of IgG4-RH,which mimicked a pituitary macroadenoma,that was detected by computed tomography(CT)and magnetic resonance imaging(MRI),and review the previous literature in order to further the understanding of IgG4-RH.CASE SUMMARY A 47-year-old man presented with a history of blurred vision for more than 2 mo,without other symptoms.A preoperative unenhanced CT scan revealed a slightly hyperdense mass in the sellar region measuring 2.5 cm×2.3 cm×1.8 cm,with a CT value of 45 HU.T1-weighted imaging(T1WI)and T2-weighted imaging showed iso-hypointensity,and gadolinium contrast-enhanced T1WI showed obvious homogeneous enhancement.The MRI revealed involvement of the pituitary gland and stalk.Preoperative laboratory tests revealed abnormal pituitary hormone levels,including an increased prolactin level,and decreased levels of insulin-like growth factor,dehydroepiandrosterone,and testosterone.The lesion was surgically resected.Postoperative histopathological examination of a tissue sample and an elevated serum IgG4 level confirmed the diagnosis of IgG4-RH.The patient was treated with cortisone acetate postoperatively and made a good recovery without developing any neurological deficit.CONCLUSION An elevated serum IgG4 concentration is the main clue for diagnosis of IgG4-RD.Imaging combined with laboratory testing is useful for preoperative diagnosis of IgG4-RH.展开更多
The expression of paired immunoglobin-like receptors A (PIR-A) and B (PIR-B) and their relationship with tolerogenic dendritic cells (T-DC) in mice were investigated. The mouse DCs line, DC2.4 cells were cultured with...The expression of paired immunoglobin-like receptors A (PIR-A) and B (PIR-B) and their relationship with tolerogenic dendritic cells (T-DC) in mice were investigated. The mouse DCs line, DC2.4 cells were cultured with the recombinant murine interleukin-10 (IL-10) and recombinant human transforming growth factor β1 (TGF-β1) respectively to develop the T-DC and stimulated with lipopolysaccharide (LPS) for 48 h to induce the mature dendritic cells (LPS-DC). Special small interfering RNAs (siRNA) molecule for PIR-B was chemically synthesized and transfected into DC2.4 cells (Si-DC) by lip2000. The expression of PIRs on DC2.4 cells were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR), flow cytometry (FCM) and Western blot. Realtime reverse transcriptase-polymerase chain reaction (Realtime-PCR) was ap- plied for measurement of PIR-A and CD80, CD86, MHC-Ⅱ mRNA expression. The allogeneic stimulating capacity of DCs was measured by mixed lymphocyte reaction (MLR) using 3H-thymidine incorporation test. The concentration of IFN-γ in supernatants of MLR from distinct groups was ana- lyzed by ELISA. The results showed that PIR positive rate was (28.65±8.12)% examined by FCM on DC2.4 cells. PIR positive rate was increased dramatically to (54.21±6.34)%, (58.78±4.70)%, (48.24±6.75)% respectively for IL-10, TGF-β1 and LPS induction (P<0.01), but there was no sig- nificantly different among the three groups (P>0.01). The semi-quantitative RT-PCR and Western blot revealed that IL-10 and TGF-β1 induced the higher PIR-B level and lower PIR-A level. On the contrary, the LPS down-regulated the PIR-B expression and up-regulated the PIR-A expression. Realtime PCR examination demonstrated that PIR-A and co-stimulating molecules such as CD80, CD86 and MHC-Ⅱ were increased significantly after stimulation with LPS. Compared with the DC2.4 cells and the LPS-DC, the T-DCs inhibited alloactived T cell proliferation and down-regulated the IFN-γ secretion in MLR supernatant. Si-DC promoted the T cell proliferation (P<0.01) and en- hanced the IFN-γ secretion (P<0.01). It was concluded that up-regulating the PIR-B and down-regulating the PIR-A expression were the general feature of phenotype and constructed the new targets for dendritic cells to acquire immune tolerance in mice. Overexpression of PIR-B can inhibit the up-regulation of the PIR-A, CD80, CD86 and MHC-Ⅱ expression, which might be the molecular mechanism for the T-DC.展开更多
基金Supported by National Key R&D Program of China,No.2019YFC0120602Clinical Research Plan of SHDC,No.SHDC2020CR3020A+2 种基金Research Startup Fund of Huashan Hospital,Fudan University,No.2021QD035Shanghai Municipal Commission of Science and Technology,No.22S31905300Greater Bay Area Institute of Precision Medicine(Guangzhou),No.KCH2310094。
文摘BACKGROUND Immunoglobin G4(IgG4)-related hypophysitis(IgG4-RH)is a rare form of IgG4-related disease(IgG4-RD),which often manifests as a single organ disease and is easily misdiagnosed as a pituitary tumor clinically and by imaging.There are few reports of imaging findings of IgG4-RH.Therefore,we describe a case of IgG4-RH,which mimicked a pituitary macroadenoma,that was detected by computed tomography(CT)and magnetic resonance imaging(MRI),and review the previous literature in order to further the understanding of IgG4-RH.CASE SUMMARY A 47-year-old man presented with a history of blurred vision for more than 2 mo,without other symptoms.A preoperative unenhanced CT scan revealed a slightly hyperdense mass in the sellar region measuring 2.5 cm×2.3 cm×1.8 cm,with a CT value of 45 HU.T1-weighted imaging(T1WI)and T2-weighted imaging showed iso-hypointensity,and gadolinium contrast-enhanced T1WI showed obvious homogeneous enhancement.The MRI revealed involvement of the pituitary gland and stalk.Preoperative laboratory tests revealed abnormal pituitary hormone levels,including an increased prolactin level,and decreased levels of insulin-like growth factor,dehydroepiandrosterone,and testosterone.The lesion was surgically resected.Postoperative histopathological examination of a tissue sample and an elevated serum IgG4 level confirmed the diagnosis of IgG4-RH.The patient was treated with cortisone acetate postoperatively and made a good recovery without developing any neurological deficit.CONCLUSION An elevated serum IgG4 concentration is the main clue for diagnosis of IgG4-RD.Imaging combined with laboratory testing is useful for preoperative diagnosis of IgG4-RH.
基金a grant from National Natu-ral Sciences Foundation of China (No. 30571755)
文摘The expression of paired immunoglobin-like receptors A (PIR-A) and B (PIR-B) and their relationship with tolerogenic dendritic cells (T-DC) in mice were investigated. The mouse DCs line, DC2.4 cells were cultured with the recombinant murine interleukin-10 (IL-10) and recombinant human transforming growth factor β1 (TGF-β1) respectively to develop the T-DC and stimulated with lipopolysaccharide (LPS) for 48 h to induce the mature dendritic cells (LPS-DC). Special small interfering RNAs (siRNA) molecule for PIR-B was chemically synthesized and transfected into DC2.4 cells (Si-DC) by lip2000. The expression of PIRs on DC2.4 cells were detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR), flow cytometry (FCM) and Western blot. Realtime reverse transcriptase-polymerase chain reaction (Realtime-PCR) was ap- plied for measurement of PIR-A and CD80, CD86, MHC-Ⅱ mRNA expression. The allogeneic stimulating capacity of DCs was measured by mixed lymphocyte reaction (MLR) using 3H-thymidine incorporation test. The concentration of IFN-γ in supernatants of MLR from distinct groups was ana- lyzed by ELISA. The results showed that PIR positive rate was (28.65±8.12)% examined by FCM on DC2.4 cells. PIR positive rate was increased dramatically to (54.21±6.34)%, (58.78±4.70)%, (48.24±6.75)% respectively for IL-10, TGF-β1 and LPS induction (P<0.01), but there was no sig- nificantly different among the three groups (P>0.01). The semi-quantitative RT-PCR and Western blot revealed that IL-10 and TGF-β1 induced the higher PIR-B level and lower PIR-A level. On the contrary, the LPS down-regulated the PIR-B expression and up-regulated the PIR-A expression. Realtime PCR examination demonstrated that PIR-A and co-stimulating molecules such as CD80, CD86 and MHC-Ⅱ were increased significantly after stimulation with LPS. Compared with the DC2.4 cells and the LPS-DC, the T-DCs inhibited alloactived T cell proliferation and down-regulated the IFN-γ secretion in MLR supernatant. Si-DC promoted the T cell proliferation (P<0.01) and en- hanced the IFN-γ secretion (P<0.01). It was concluded that up-regulating the PIR-B and down-regulating the PIR-A expression were the general feature of phenotype and constructed the new targets for dendritic cells to acquire immune tolerance in mice. Overexpression of PIR-B can inhibit the up-regulation of the PIR-A, CD80, CD86 and MHC-Ⅱ expression, which might be the molecular mechanism for the T-DC.
