{"id":9429,"date":"2020-04-28T05:34:44","date_gmt":"2020-04-28T08:34:44","guid":{"rendered":"https:\/\/doctorhoogstra.com\/es\/wiki\/patologia-de-la-enfermedad-de-la-piel-relacionada-con-igg4\/"},"modified":"2020-04-30T21:34:28","modified_gmt":"2020-05-01T00:34:28","slug":"doenca-de-pele-patologia-relacionada-a-igg4","status":"publish","type":"wiki","link":"https:\/\/doctorhoogstra.com\/pt\/wiki\/patologia-de-la-enfermedad-de-la-piel-relacionada-con-igg4\/","title":{"rendered":"Patologia da doen\u00e7a de pele relacionada com IgG4"},"content":{"rendered":"<p><\/p><div id=\"ez-toc-container\" class=\"ez-toc-v2_0_88 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Conte\u00fado<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Alternar tabela de conte\u00fado\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Alternar<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewbox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewbox=\"0 0 24 24\" version=\"1.2\" baseprofile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 eztoc-toggle-hide-by-default' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/patologia-de-la-enfermedad-de-la-piel-relacionada-con-igg4\/#Introduccion\" >Introdu\u00e7\u00e3o<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/patologia-de-la-enfermedad-de-la-piel-relacionada-con-igg4\/#Histologia-de-la-enfermedad-cutanea-relacionada-con-IgG4\" >Histologia da doen\u00e7a de pele relacionada \u00e0 IgG4<\/a><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/patologia-de-la-enfermedad-de-la-piel-relacionada-con-igg4\/#Patologia-de-la-enfermedad-de-la-piel-relacionada-con-IgG4\" >Patologia da doen\u00e7a de pele relacionada com IgG4<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/patologia-de-la-enfermedad-de-la-piel-relacionada-con-igg4\/#Tinciones-especiales-de-la-enfermedad-de-la-piel-relacionada-con-IgG4\" >Colora\u00e7\u00f5es especiais para doen\u00e7as de pele relacionadas a IgG4<\/a><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/patologia-de-la-enfermedad-de-la-piel-relacionada-con-igg4\/#Enfermedad-cutanea-relacionada-con-IgG4-manchas-especiales\" >Doen\u00e7a de pele relacionada \u00e0 IgG4: manchas especiais<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/patologia-de-la-enfermedad-de-la-piel-relacionada-con-igg4\/#Clasificacion-de-la-enfermedad-cutanea-relacionada-con-IgG4\" >Classifica\u00e7\u00e3o de doen\u00e7as de pele relacionadas a IgG4<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/doctorhoogstra.com\/pt\/wiki\/patologia-de-la-enfermedad-de-la-piel-relacionada-con-igg4\/#Diagnostico-diferencial-de-la-enfermedad-cutanea-relacionada-con-IgG4\" >Diagn\u00f3stico diferencial de doen\u00e7as de pele relacionadas a IgG4<\/a><\/li><\/ul><\/nav><\/div>\n\n<section class=\"textBlock\">\n<h2><span class=\"ez-toc-section\" id=\"Introduccion\"><\/span>Introdu\u00e7\u00e3o<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>A doen\u00e7a relacionada \u00e0 IgG4 \u00e9 uma entidade descrita recentemente. \u00c9 caracterizado por:<\/p>\n<ul>\n<li>N\u00edveis elevados de IgG4 circulante (&gt;135 mg\/dL) em pacientes 60 a 70%<\/li>\n<li>Tecido <span class=\"term\" data-term-id=\"543\">infiltra\u00e7\u00e3o<\/span> de IgG4+ <span class=\"term\" data-term-id=\"1513\">plasma<\/span> c\u00e9lulas<\/li>\n<li>Altera\u00e7\u00e3o fibroinflamat\u00f3ria em v\u00e1rios \u00f3rg\u00e3os, como p\u00e2ncreas, saliva, <span class=\"term\" data-term-id=\"1434\">lacrimal<\/span>etc.<\/li>\n<li>Surpreendente <span class=\"term\" data-term-id=\"474\">histol\u00f3gico<\/span> semelhan\u00e7as entre \u00f3rg\u00e3os.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Histologia-de-la-enfermedad-cutanea-relacionada-con-IgG4\"><\/span>\n<span class=\"term\" data-term-id=\"128\">Histologia<\/span> de doen\u00e7a de pele relacionada \u00e0 IgG4<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>Linfoplasmoc\u00edtico denso <span class=\"term\" data-term-id=\"541\">infiltrar<\/span> (figuras 1,2)<\/li>\n<li>estoriforme <span class=\"term\" data-term-id=\"102\">fibrose<\/span> (fibrose em padr\u00e3o de estrela, figura 3)<\/li>\n<li>Tecido moderado a moderado <span class=\"term\" data-term-id=\"83\">eosinofilia<\/span> (Figura 4)<\/li>\n<\/ul>\n<p>Em geral, o m\u00ednimo para fazer o diagn\u00f3stico para a maioria dos tecidos \u00e9 de 30 a 50 c\u00e9lulas positivas para IgG4 por campo de grande aumento. No entanto, em alguns \u00f3rg\u00e3os ou tecidos, por exemplo, rim, apenas 10 c\u00e9lulas plasm\u00e1ticas positivas para IgG4 por campo de grande aumento podem ser suficientes.<\/p>\n<section class=\"textBlock imageLinkBlockTitle\">\n<h5 class=\"colour--primary\"><span class=\"ez-toc-section\" id=\"Patologia-de-la-enfermedad-de-la-piel-relacionada-con-IgG4\"><\/span>Patologia da doen\u00e7a de pele relacionada com IgG4<span class=\"ez-toc-section-end\"><\/span><\/h5>\n<\/section>\n<section class=\"imageLinkBlock\">\n<div class=\"flex\">\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='relacionado a igg4-1__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-3605057-3789547' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/igg4-related-1__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-3605057.jpg'>\n<\/div>\n<p class=\"p-small\">figura 1<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='relacionado a igg4-2__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-9909157-5878833' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/igg4-related-2__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-9909157.jpg'>\n<\/div>\n<p class=\"p-small\">Figura 2<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='relacionado a igg4-3__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-7822586-6690863' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/igg4-related-3__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-7822586.jpg'>\n<\/div>\n<p class=\"p-small\">Figura 3<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='relacionado a igg4-4__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-3393964-1543780' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/igg4-related-4__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-3393964.jpg'>\n<\/div>\n<p class=\"p-small\">Figura 4<\/p>\n<\/p><\/div>\n<\/section>\n<div class=\"clearfix imageLinkBlock\"><\/div>\n<div id=\"square-placement-country-holder\" class=\"country-dependent advert\">\n<div class=\"box-placement square-placement\">\n<div class=\"advert__frame\">\n<div id=\"dermnet-dermnet-mobbox\">\n<\/div><\/div><\/div><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Tinciones-especiales-de-la-enfermedad-de-la-piel-relacionada-con-IgG4\"><\/span>Colora\u00e7\u00f5es especiais para doen\u00e7as de pele relacionadas a IgG4<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>O spot CD3 ilustra a densa popula\u00e7\u00e3o de <span class=\"term\" data-term-id=\"419\">T <span class=\"term\" data-term-id=\"421\">linf\u00f3citos<\/span><\/span>  (Figura 5)<\/li>\n<li>Colora\u00e7\u00e3o CD20 ilustra popula\u00e7\u00e3o de c\u00e9lulas plasm\u00e1ticas <span class=\"term\" data-term-id=\"430\">C\u00e9lulas B<\/span> (figura 6)<\/li>\n<li>A colora\u00e7\u00e3o anti-IgG4 que parece marrom mostra impressionantes &gt;250 c\u00e9lulas B IgG4+ no campo de alta pot\u00eancia (Figura 7)<\/li>\n<\/ul>\n<section class=\"textBlock imageLinkBlockTitle\">\n<h5 class=\"colour--primary\"><span class=\"ez-toc-section\" id=\"Enfermedad-cutanea-relacionada-con-IgG4-manchas-especiales\"><\/span>Doen\u00e7a de pele relacionada \u00e0 IgG4: manchas especiais<span class=\"ez-toc-section-end\"><\/span><\/h5>\n<\/section>\n<section class=\"imageLinkBlock\">\n<div class=\"flex\">\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='relacionado a igg4-5__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-1945183-1810757' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/igg4-related-5__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-1945183.jpg'>\n<\/div>\n<p class=\"p-small\">Figura 5<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='relacionado a igg4-6__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-4793320-9122117' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/igg4-related-6__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-4793320.jpg'>\n<\/div>\n<p class=\"p-small\">Figura 6<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='relacionado a igg4-7__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-5662114-5369549' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/igg4-related-7__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-5662114.jpg'>\n<\/div>\n<p class=\"p-small\">Figura 7<\/p>\n<\/p><\/div>\n<\/section>\n<div class=\"clearfix imageLinkBlock\"><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Clasificacion-de-la-enfermedad-cutanea-relacionada-con-IgG4\"><\/span>Classifica\u00e7\u00e3o de doen\u00e7as de pele relacionadas a IgG4<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Yokura et al (2014) propuseram uma classifica\u00e7\u00e3o de doen\u00e7as de pele relacionadas a IgG4 que a divide em <span class=\"term\" data-term-id=\"949\">prim\u00e1rio<\/span>, les\u00f5es formadoras de massa devido \u00e0 infiltra\u00e7\u00e3o direta de c\u00e9lulas plasm\u00e1ticas e les\u00f5es secund\u00e1rias que s\u00e3o devidas \u00e0 media\u00e7\u00e3o de IgG4 <span class=\"term\" data-term-id=\"148\">inflama\u00e7\u00e3o<\/span> atrav\u00e9s de mecanismos secund\u00e1rios.<\/p>\n<p>Les\u00f5es prim\u00e1rias incluem:<\/p>\n<ul>\n<li>\n<span class=\"term\" data-term-id=\"47\">Cut\u00e2neo<\/span> plasmocitose<\/li>\n<li>Pseudolinfoma e angiolinf\u00f3ide <span class=\"term\" data-term-id=\"136\">hiperplasia<\/span> com eosinofilia<\/li>\n<li>Doen\u00e7a de Mikulicz (inflama\u00e7\u00e3o das gl\u00e2ndulas lacrimais e salivares).<\/li>\n<\/ul>\n<p>Les\u00f5es secund\u00e1rias incluem:<\/p>\n<ul>\n<li>Les\u00f5es semelhantes \u00e0 psor\u00edase<\/li>\n<li>Indeterminado <span class=\"term\" data-term-id=\"938\">maculopapular<\/span> ou <span class=\"term\" data-term-id=\"967\">eritematoso<\/span> les\u00f5es<\/li>\n<li>hipergamaglobulinemia, <span class=\"term\" data-term-id=\"250\">roxa<\/span> e <span class=\"term\" data-term-id=\"293\">urtic\u00e1ria<\/span> <span class=\"term\" data-term-id=\"1091\">vasculite<\/span>.<\/li>\n<li>\n<span class=\"term\" data-term-id=\"765\">Isqu\u00eamico<\/span> <span class=\"term\" data-term-id=\"1267\">d\u00edgito<\/span>\n<\/li>\n<\/ul>\n<p>Os crit\u00e9rios diagn\u00f3sticos histol\u00f3gicos propostos para a dermatose s\u00e3o os seguintes:<\/p>\n<ul>\n<li>Doen\u00e7a de pele prim\u00e1ria relacionada a IgG4<\/li>\n<li>Marcado <span class=\"term\" data-term-id=\"420\">linf\u00f3cito<\/span> e infiltra\u00e7\u00e3o de plasm\u00f3citos, IgG4 + \/ IgG + &gt; 40%<\/li>\n<li>N\u00ba de c\u00e9lulas IgG4+ por campo de alta pot\u00eancia &gt; 10.<\/li>\n<\/ul>\n<p>Doen\u00e7a cut\u00e2nea secund\u00e1ria relacionada a IgG4<\/p>\n<ul>\n<li>Infiltra\u00e7\u00e3o de c\u00e9lulas plasm\u00e1ticas com IgG4+\/IgG+&gt;40% e\/ou <span class=\"term\" data-term-id=\"228\">perivascular<\/span> IgG4 <span class=\"term\" data-term-id=\"370\">declara\u00e7\u00e3o<\/span>\n<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Diagnostico-diferencial-de-la-enfermedad-cutanea-relacionada-con-IgG4\"><\/span>\n<span class=\"term\" data-term-id=\"813\">Diagn\u00f3stico diferencial<\/span> de doen\u00e7a de pele relacionada \u00e0 IgG4<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>O diagn\u00f3stico diferencial de <span class=\"term\" data-term-id=\"427\">imunoglobulina<\/span> A doen\u00e7a relacionada ao G4 (IgG4-RD) \u00e9 ampla e depende do local espec\u00edfico de envolvimento e da apresenta\u00e7\u00e3o cl\u00ednica.<\/p>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>Introducci\u00f3n La enfermedad relacionada con IgG4 es una entidad recientemente descrita. Se caracteriza por: Altos niveles de IgG4 circulante (&gt; 135 mg \/ dL) en 60 a 70% de los&#8230;<\/p>","protected":false},"author":8,"featured_media":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","format":"standard","meta":{"footnotes":""},"categories":[204],"tags":[205],"class_list":["post-9429","wiki","type-wiki","status-publish","format-standard","category-glosario-definiciones","tag-patologia"],"_links":{"self":[{"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/wiki\/9429","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/wiki"}],"about":[{"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/types\/wiki"}],"author":[{"embeddable":true,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/comments?post=9429"}],"version-history":[{"count":0,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/wiki\/9429\/revisions"}],"wp:attachment":[{"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/media?parent=9429"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/categories?post=9429"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/doctorhoogstra.com\/pt\/wp-json\/wp\/v2\/tags?post=9429"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}