Immunohistochemistry May Not Replace Immunofluorescence in Paraffin-embedded Tissue for Detecting Masked Monoclonal Immunoglobulin Deposits: A Case Report

Yasuhiro Oda; Yoichiro Ikeda; Hiroyuki Abe; Akinori Hashiguchi; Kazuhito Hatanaka; Toshihiro Sawai; Tetsuo Ushiku; Masaomi Nangaku

doi:10.2169/internalmedicine.1117-22

This article has now been updated. Please use the final version.

Immunohistochemistry May Not Replace Immunofluorescence in Paraffin-embedded Tissue for Detecting Masked Monoclonal Immunoglobulin Deposits: A Case Report

Yasuhiro Oda, Yoichiro Ikeda, Hiroyuki Abe, Akinori Hashiguchi, Kazuhito Hatanaka, Toshihiro Sawai, Tetsuo Ushiku, Masaomi Nangaku

Author information

Yasuhiro Oda
Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan
Yoichiro Ikeda
Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan
Hiroyuki Abe
Department of Pathology, The University of Tokyo Graduate School of Medicine, Japan
Akinori Hashiguchi
Department of Pathology, Keio University School of Medicine, Japan
Kazuhito Hatanaka
Department of Pathology, Tokai University School of Medicine, Japan
Toshihiro Sawai
Department of Pediatrics, Shiga University of Medical Science, Japan
Tetsuo Ushiku
Department of Pathology, The University of Tokyo Graduate School of Medicine, Japan
Masaomi Nangaku
Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan

Keywords: masked monoclonal immunoglobulins, antigen retrieval, immunohistochemistry, immunofluorescence

JOURNAL OPEN ACCESS Advance online publication

Article ID: 1117-22

DOI https://doi.org/10.2169/internalmedicine.1117-22

The final version of this article is now available: Vol. 62 (2023), No. 24 pp. 3657-3661

Details

Abstract

An 84-year-old man developed a membranoproliferative glomerulonephritis pattern of injury, and the most likely cause detected during a workup was monoclonal IgG-λ in the urine and serum. Predominant IgG and λ light chain deposition was confirmed only by immunofluorescence using formalin-fixed, paraffin-embedded tissue and not by immunohistochemistry. A smaller and non-linear dynamic range of immunohistochemistry makes it less quantitative than immunofluorescence staining and may explain why immunohistochemistry failed to detect the light chain restriction. This case suggests that immunohistochemistry may not serve as a substitute for immunofluorescence on formalin-fixed, paraffin-embedded tissue in detecting masked monoclonal immunoglobulin deposits, although further research is warranted.

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