MORPHOLOGY
• Dense lymphoplasmacytic infiltrate in a fibrotic stroma with storiform pattern and obliterative phlebitis
• The absence of neutrophils, granulomas, and giant cells is essential
OTHER HIGH YIELD POINTS
• Can have bilateral involvement of the breast and lymphadenopathy
• Occurs in middle-aged females; ~50% have hypocomplementemia
• May have substantial weight loss or peripheral eosinophilia
• Other organs are often involved at the time of diagnosis
• IHC: Increased IgG4 positive plasma cells (>40% IgG4/IgG ratio)
Image: Dense lymphoplasmacytic infiltrate in a fibrotic stroma
Image: Dense lymphoplasmacytic infiltrate in a fibrotic stroma with storiform pattern and obliterative phlebitis. Neutrophils, granulomas, and giant cells are absent.
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