An ulcerated gastric ulcer and pseudotumour with pancreatic affectation associated with immunoglobulin G4-related disease: a case report and literature review

Moreno, María Isabel Ortuño; Ñíguez, Belén Ferri; Barba, Enrique M.; Hernández, Juan Ángel Fernández

doi:10.17235/reed.2017.4996/2017

Cited by 3 publications

(6 citation statements)

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“…Table 2 presents the baseline demographics, diagnostic findings, and chief clinical features of gastric IgG4‐RD from the individual cases ( n = 42) 7–12,17–47 . There were slightly more male cases than female cases (59.5% male).…”

Section: Resultsmentioning

confidence: 99%

Clinicopathological characteristics of gastric IgG4‐related disease: Systematic scoping review

Sawada

Czech

Silangcruz

et al. 2022

J of Gastro and Hepatol

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Background and Aim: Gastric IgG4-related disease (IgG4-RD) can mimic malignancy, submucosal tumors (SMT), and ulcers, leading to over-triage and unnecessary medical interventions such as gastrectomy. The variability in the clinicopathological presentation of IgG4-related disease is not yet well defined, posing a diagnostic challenge. Methods: Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "gastritis," "stomach," "gastrointestinal stromal tumor," and "IgG4-RD" from their inception to December 28, 2021. Results: Thirty-nine articles, including 2 observational studies and 42 cases, were included in the systematic review. While bottom-heavy lymphoplasmacytic mucosal infiltration is a characteristic finding of gastric IgG4-RD, it was only present in less than half of the patients in the observational studies. Patients with gastric IgG4-RD were more likely to be diagnosed with gastrointestinal stromal tumor (GIST), gastric cancer, or peptic ulcer disease and their clinical course involved resection (51.3%) or even gastrectomy. Diagnosis of gastric IgG4-RD was most frequently made by post-operative pathological analysis. Conclusion: This systematic review summarizes the current understanding of the characteristics of gastric IgG4-RD. Increased awareness of gastric IgG4-RD as a differential diagnosis of gastric SMT or ulcers among clinicians is crucial in order to reduce unnecessary high-risk, invasive interventions.

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Section: Resultsmentioning

confidence: 99%

Clinicopathological characteristics of gastric IgG4‐related disease: Systematic scoping review

Sawada

Czech

Silangcruz

et al. 2022

J of Gastro and Hepatol

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“…Clinical features of IgG4-related diseases include: edema, diffuse mass in one or more organs, elevated IgG4 serum levels, or abundance of IgG4-rich plasmatic and lymphocytic cells infiltrating and causing fibrosis [ 11 , 12 ]. In medium-caliber venous vessels, fibrosis can be observed in late stages due to increased lympho-plasmatic infiltration [ 12 ]. IgG4 serum levels can be used as a diagnostic aid, however they are not always elevated, nor specific to IgG4-related diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Gastric compromise in IgG4-related disease is unusual but can present itself in two forms: 1) diffuse wall thickening or presence of a mass or polyp, or 2) ulcerative compromise [ 2 , 3 , 12 , 15 ]. Although rarer, the latter can be single or multiple ulcers and often affects the pancreas [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, H. Pylori treatment can aggravate ulcers and the resulting clinical outcome of the patient [ 3 , 15 ]. Several other case reports have shown that gastric compromise is often accompanied by other affected organs [ 12 ]. This emphasizes the diagnostic challenge of IgG4-related diseases given its similarities with stromal and neuroendocrine tumors.…”

Section: Discussionmentioning

confidence: 99%

“…This emphasizes the diagnostic challenge of IgG4-related diseases given its similarities with stromal and neuroendocrine tumors. Hence why many cases are diagnosed after surgical or endoscopic tumor resection and pathological specimen is completed [ 2 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Immunoglobulin G4-related gastric pseudotumor – An impostor: Case report

Mosquera

Gómez

Herrera

et al. 2020

International Journal of Surgery Case Reports

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Highlights Gastric pseudotumors are rare entities that resemble gastric neoplasias and often unrecognized. Suggestive malignant gastric masses can in fact result IgG4-related pseudotumors. Gastric pseudotumors are often an incidental diagnosis upon histologic analysis after surgical resection. Understanding gastric pseudotumors can reduce unwarranted surgical intervention.

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Frequency, clinical picture, diagnosis, and differential diagnosis of the pathology of the digestive tract (esophagus, stomach, and bowel) in IgG4-related disease (autoimmune pancreatitis)

Gubergrits

2023

Bul. of the Club of Pancr.

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Despite the publication of European guidelines for the diagnosis and treatment of IgG4-related disease (IgG4-RD), this problem is very complicated from a practical point of view. There are many publications about autoimmune pancreatitis and liver and biliary tract lesions in IgG4-RD, but the data on the digestive tract lesions are not sufficient. Gastrointestinal manifestations of IgG4-RD are considered to be rare or very rare. IgG4-RD presenting as esophageal lesions is rare condition. Only single clinical cases are available. I. Obiorah et al. reported the highest number of cases of IgG4-related esophagitis (8 cases). Interestingly, 7/8 cases reported by I. Obiorah et al. were males (age range: 18 to 79 years), and most patients had dysphagia as the most prominent symptom, with erosions and strictures at endoscopy. Histologically, all patients had a lymphoplasmacytic infiltrate and storiform fibrosis, while obliterative phlebitis was observed in 3/8 patients. Hence, 2 of the 3 major histological “Boston criteria” of IgG4-RD were fulfilled in all patients. Besides, all patients had at least 50 IgG4-positive cells per HPF (range: 50–110), and IgG4/IgG ratios of at least 50% (range: 50–90%). Of I. Obiorah’s patients, s-IgG4 had only been measured in three — all of whom had values in the normal range. Esophageal strictures were identified in three patients, two patients had achalasia. Based on K. Notohara’s series and the other published cases, it can be concluded that gastric IgG4-RD often (but not always) seems to be clinically asymptomatic, that s-IgG4 is elevated in a considerable number of cases, and histologically, that at least two of the Boston criteria often are found. The recommended cut-off of 50 IgG4-positive cells and IgG4/IgG ratios of >40% was often fulfilled in the reported cases of IgG4-RD. There are few reports of IgG4-RD involving the duodenum, duodenal papilla, ileum with small bowel obstruction caused by pseudotumor or sclerosing disease of the small bowel with luminal narrowing. There are case reports of IgG4-RD with lesion of ileocecal area with an obstructing ileocecal mass and appendix, mimicking Crohn’s disease, appendicitis or appendiceal tumor. IgG4-related inflammatory bowel disease may — rarely — also be one of manifestations of IgG4-RD. Treatment should be conducted in accordance with European guidelines.

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An ulcerated gastric ulcer and pseudotumour with pancreatic affectation associated with immunoglobulin G4-related disease: a case report and literature review

Cited by 3 publications

References 9 publications

Clinicopathological characteristics of gastric IgG4‐related disease: Systematic scoping review

Clinicopathological characteristics of gastric IgG4‐related disease: Systematic scoping review

Immunoglobulin G4-related gastric pseudotumor – An impostor: Case report

Frequency, clinical picture, diagnosis, and differential diagnosis of the pathology of the digestive tract (esophagus, stomach, and bowel) in IgG4-related disease (autoimmune pancreatitis)

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