PMC7073487_01
Image obtained using transrectal ultrasound at the second biopsy showing an enlarged prostate (axial view). The estimated prostate volume was 49 cm3. Magnetic resonance imaging was not performed because the patient had undergone femoral head replacement.
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One month later, the patient had elevated PSA levels of 180 ng/mL, and a second prostate biopsy was performed Figure 1.
Paraffin section of prostate biopsy tissue. (a-c) Hematoxylin and eosin (H&E) staining and immunohistochemical staining for (d, e) IgG4 and (f) IgG. Original magnification: (d, e) x100; (a, c) x200; and (b, e) x400. H&E staining shows storiform fibrosis, exocrine glands with periglandular fibrosis, and lymphoplasmacytic and eosinophilic infiltration (a, b). Adenocarcinoma, Gleason score 5 + 4, was found in 1/12 needle cores, which occupied 10% of the core area, at the second biopsy (c). Indirect immunohistochemical staining for IgG4 revealed multiple IgG4-positive plasma cells (>50/high-power field (HPF)) infiltrating the prostate (d, e). The ratio of IgG4-positive/IgG-positive plasma cells was >50% (the histopathological diagnostic criteria for IgG4-related disease included marked lymphoplasmacytic infiltration, fibrosis, IgG4 positivity in >40% of IgG-positive plasma cells, and >10 IgG4-positive plasma cells/HPF of a biopsy sample).
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Adenocarcinoma (Gleason score 5 + 4) was detected in 1/12 needle cores Figure 2(c). Moreover, we detected abundant plasma cell infiltration with periglandular storiform fibrosis in prostate tissue samples Figures 2(a) and 2(b). Although plasma cell clonality was not detected, IgG4 immunochemical staining demonstrated IgG4-positive plasma cells Figures 2(d) and 2(e). The ratio of IgG4-positive/IgG-positive plasma cells was >50% Figure 2(f).