{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:20:56Z","timestamp":1792693256750,"version":"4.5.0"},"reference-count":35,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["23FC1015"],"award-info":[{"award-number":["23FC1015"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["23FC1025"],"award-info":[{"award-number":["23FC1025"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["22ek0109589h0001"],"award-info":[{"award-number":["22ek0109589h0001"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["23K1447605"],"award-info":[{"award-number":["23K1447605"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2024,1,22]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Aims and methods<\/jats:title>\n                    <jats:p>Idiopathic multicentric Castleman disease (iMCD) is currently considered to be classified into three clinical subtypes, including idiopathic plasmacytic lymphadenopathy (IPL), thrombocytopaenia, anasarca, fever, reticulin fibrosis\/renal dysfunction, organomegaly (TAFRO) and not otherwise specified (NOS). Among the three, iMCD-IPL closely mimics IgG4-related disease (IgG4-RD). In diagnosing IgG4-RD, it is sometimes challenging to distinguish iMCD-IPL patients that also meet the histological diagnostic criteria for IgG4-RD. In this study, we focused on the number of IgG4-positive cells in the lymph nodes and analysed the relationship with laboratory findings to distinguish iMCD-IPL from IgG4-RD. Thirty-nine patients with iMCD-IPL and 22 patients with IgG4-RD were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the cases considered to be iMCD-IPL, 33.3% (13\/39) cases also met the histological diagnostic criteria for IgG4-RD and serum IgG4 levels were not different between the two groups. However, the serum IgG4\/IgG ratio was significantly higher in IgG4-RD, with a cut-off value of 19.0%. Additionally, a significant positive correlation between serum IgG levels and the number of IgG4-positive cells was observed in iMCD-IPL (p=0.001). The serum IgG cut-off value for distinguishing iMCD-IPL meeting histological criteria for IgG4-RD from other iMCD-IPL was 5381\u2009mg\/dL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>iMCD-IPL cases with high serum IgG levels (&gt;5000\u2009mg\/dL) were likely to meet the diagnostic criteria for IgG4-RD because of the numerous IgG4-positive cells observed. A combination of clinical presentations, laboratory values including the serum IgG4\/IgG ratios and histological analysis is crucial for diagnosis of IgG4-RD and iMCD-IPL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jcp-2023-209280","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T13:25:44Z","timestamp":1708435544000},"page":"43-49","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Diagnostic challenges of the idiopathic plasmacytic lymphadenopathy (IPL) subtype of idiopathic multicentric Castleman disease (iMCD): Factors to differentiate from IgG4-related disease"],"prefix":"10.1136","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1485-0527","authenticated-orcid":false,"given":"Asami","family":"Nishikori","sequence":"first","affiliation":[{"name":"Department of Molecular Hematopathology, Okayama University Graduate School of Health Sciences, Okayama, Japan"},{"name":"Research Program for Intractable Disease by Ministry of Health, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8433-4870","authenticated-orcid":false,"given":"Midori Filiz","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Molecular Hematopathology, Okayama University Graduate School of Health Sciences, Okayama, Japan"},{"name":"Research Program for Intractable Disease by Ministry of Health, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7367-8184","authenticated-orcid":false,"given":"David C","family":"Fajgenbaum","sequence":"additional","affiliation":[{"name":"Department of Medicine, Center for Cytokine Storm Treatment & Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"},{"name":"Castleman Disease Collaborative Network, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0224-7501","authenticated-orcid":false,"given":"Yoshito","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan"},{"name":"Department of Medicine, University of Hawai\u2019i, Honolulu, Hawai\u02bbi, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanna","family":"Maehama","sequence":"additional","affiliation":[{"name":"Department of Molecular Hematopathology, Okayama University Graduate School of Health Sciences, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoka","family":"Haratake","sequence":"additional","affiliation":[{"name":"Department of Molecular Hematopathology, Okayama University Graduate School of Health Sciences, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Tabata","sequence":"additional","affiliation":[{"name":"Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4613-2116","authenticated-orcid":false,"given":"Mitsuhiro","family":"Kawano","sequence":"additional","affiliation":[{"name":"Research Program for Intractable Disease by Ministry of Health, Tokyo, Japan"},{"name":"Department of Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4332-5254","authenticated-orcid":false,"given":"Naoya","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tokai University School of Medicine, Isehara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Momose","sequence":"additional","affiliation":[{"name":"Department of Pathology, Saitama Medical University, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remi","family":"Sumiyoshi","sequence":"additional","affiliation":[{"name":"Research Program for Intractable Disease by Ministry of Health, Tokyo, Japan"},{"name":"Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2077-4428","authenticated-orcid":false,"given":"Tomohiro","family":"Koga","sequence":"additional","affiliation":[{"name":"Research Program for Intractable Disease by Ministry of Health, Tokyo, Japan"},{"name":"Department of Immunology and Rheumatology, Division of Advanced Preventive Medical 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