IgG4-related disease mimicking pancreatic cancer: Case report and review of the literature

Sulieman, Ibnouf; Mahfouz, Ahmed; Kuwari, Einas Al; Szabados, Lajos; Elmoghazy, Walid; Elaffandi, Ahmed; Khalaf, Hatem

doi:10.1016/j.ijscr.2018.07.030

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…Eighteen of the 38 individuals initially thought to have a malignancy were believed to have lymphoma. IgG4-related lymphadenopathy is an immunemediated process characterized by lymphoplasmacytic infiltrates with abundant IgG4-positive plasma cells and fibrosis [21], the morphologic features resembling reactive lymphoid hyperplasia. This finding is not surprising given that lymph node involvement is a common manifestation of IgG4-RD [12,22].…”

Section: Common Malignancy Mimickersmentioning

confidence: 99%

IgG4-Related Disease as Mimicker of Malignancy

Zhou

Murray

Cartagena

et al. 2021

SN Compr. Clin. Med.

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Background IgG4-related disease (IgG4-RD) is an immune-mediated disease that may present as a tumefactive lesion in nearly any organ. These mass lesions often resemble malignancy both clinically and radiologically, and some patients undergo surgical resection which could possibly be avoided with early recognition of IgG4-RD. We performed a retrospective single-center study examining how many patients with IgG4-RD were initially believed to have malignancy, with particular attention to those who underwent potentially avoidable surgical procedures. Methods Sixty-three patients with biopsy confirmed IgG4-related disease were included. Clinical, laboratory, radiological, and histological data were collected and analyzed. Results Over 60% of patients (38/63) were initially thought to have a malignancy when they initially presented with symptomatic IgG4-RD. The most common types of malignancy suspected were lymphoma (18/38) and pancreatic cancer (11/38). Of the 38 patients with suspected malignancy, 14 underwent an invasive intervention either to alleviate the severity of their symptoms or as treatment for their presumed malignancy. These included Whipple resection/attempted Whipple (3), nephrectomy (3), bile duct resection and reconstruction (1), removal of other abdominal/retroperitoneal masses (3), and stenting of obstructed organs (4). Conclusion IgG4-RD should be on the differential diagnosis of patients with mass lesions, in particular those with pancreatic masses and obstructive jaundice, extensive lymphadenopathy, or retroperitoneal masses. Oncologists and other physicians involved in cancer care should be aware of the various manifestations and diagnostic approach to IgG4-RD in order to provide accurate diagnosis and minimize unnecessary invasive procedures. While some procedures in this study, such as stenting of obstructed organs, were required regardless of diagnosis, others could have potentially been avoided or attenuated with early recognition of IgG4-RD. Patients with mass lesions suspicious for IgG4-RD should have serum protein electrophoresis, IgG subclass measurement, and, where possible, tissue biopsy before undergoing major surgical resection. Consultation with a physician experienced in IgG4-RD is recommended.

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Section: Common Malignancy Mimickersmentioning

confidence: 99%

IgG4-Related Disease as Mimicker of Malignancy

Zhou

Murray

Cartagena

et al. 2021

SN Compr. Clin. Med.

View full text Add to dashboard Cite

show abstract

“…Obstructive jaundice is an increasingly recognized complication of IgG4-related disease due to either IgG4-related sclerosing cholangitis or obstruction of the biliary system by formation of a pancreatic pseudotumor as seen in our patient. [1][2][3] IgG4-related disease tends to respond well to corticosteroids, and recognition of this entity is important to avoid unnecessary procedures such as pancreatic mass resection or biliary stent placement. 4 Potential Competing Interests: The authors report no competing interests.…”

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confidence: 99%