Clivus Inflammatory Pseudotumor Associated with Immunoglobulin G4-Related Disease

Ding, Guanfu; Xiong, Ji; Zhu, Hongda; Hua, Lingyang; Xie, Qing; Gong, Yi

doi:10.1016/j.wneu.2018.06.174

Cited by 15 publications

(25 citation statements)

References 23 publications

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“…When hypertrophic pachymeningitis reveals a focal mass, it is difficult to distinguish from a tumor, such as meningioma and/or solitary fibrous tumor, preoperatively [2,4,5]. Tang et al reported a case of clivus massive IgG4-related disease similar to the present case [5]. In their report, the mass was preoperatively diagnosed as meningioma, similarly to the present case, and both the postoperatively evaluated peripheral blood IgG and IgG4 were within the reference range [5].…”

supporting

confidence: 64%

“…Hypertrophic pachymeningitis usually exhibits a diffusely invasive pattern, but rarely demonstrates a focal mass as in the present case or in a few other case reports [2][3][4][5]. When hypertrophic pachymeningitis reveals a focal mass, it is difficult to distinguish from a tumor, such as meningioma and/or solitary fibrous tumor, preoperatively [2,4,5]. Tang et al reported a case of clivus massive IgG4-related disease similar to the present case [5].…”

supporting

confidence: 63%

“…IgG4-related hypertrophic pachymeningitis is being increasingly recognized, but a consensus concerning the optimal diagnostic approach and therapeutic approach remains lacking [1]. Hypertrophic pachymeningitis usually exhibits a diffusely invasive pattern, but rarely demonstrates a focal mass as in the present case or in a few other case reports [2][3][4][5]. When hypertrophic pachymeningitis reveals a focal mass, it is difficult to distinguish from a tumor, such as meningioma and/or solitary fibrous tumor, preoperatively [2,4,5].…”

mentioning

confidence: 88%

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Treatment-responsive case of focal clivus IgG4-related hypertrophic pachymeningitis mimicking meningioma; case report

et al. 2021

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supporting

confidence: 64%

supporting

confidence: 63%

mentioning

confidence: 88%

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Treatment-responsive case of focal clivus IgG4-related hypertrophic pachymeningitis mimicking meningioma; case report

et al. 2021

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“…As a dural-based lesion, meningiomas can be misdiagnosed, especially when the radiologists are not familiar with the differential diagnosis of other dural-based lesions. For example, the "dural tail sign" on enhanced T1-weighted sequences, a characteristic imaging sign often regarded as the representative of meningiomas (10), can also be positive in other diseases including sarcoidosis (11), lymphoma (12), metastases (13)(14)(15) and other lesions (16,17). Also, some imaging features, such as the peritumoral edema and morphological irregularity of the meningioma, which may suggest an aggressive pattern, have not been validated yet (18,19).…”

Section: Introductionmentioning

confidence: 99%

The Current State of Radiomics for Meningiomas: Promises and Challenges

Zhang

Russo

et al. 2020

Front. Oncol.

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Meningiomas are the most common primary tumors of the central nervous system. Given the fact that the majority of meningiomas are benign, the preoperative risk stratification and treatment strategy decision-making highly rely on the conventional subjective radiologic evaluation. However, this traditional diagnostic and treatment modality may not be effective in patients with aggressive-growing tumors or symptomatic patients with potential risk of recurrence after surgical resection or radiotherapy, as this passive "wait and see" strategy could miss the optimal opportunity of intervention. Radiomics, a new rising discipline, translates high-dimensional image information into abundant mathematical data by multiple computational algorithms. It provides an objective and quantitative approach to interpret the imaging data, rather than the subjective and qualitative interpretation from relatively limited human visual observation. In fact, the enormous amount of information generated by radiomics analyses provides radiological to histopathological tumor information, which are visually imperceptible, and offers technological basis to its applications amid diagnosis, treatment, and prognosis. Here, we review the latest advancements of radiomics and its applications in the prediction of the pathological grade, pathological subtype, recurrence possibility, and differential diagnosis of meningiomas, and the potential and challenges in general clinical applications. In this review, we highlight the generalization of shared radiomic features among different studies and compare different performances of popular algorithms. At last, we discuss several possible aspects of challenges and future directions in the development of radiomic applications in meningiomas.

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“…Immunoglobulin G4-related disease is a chronic and fibrotic inflammatory disease involving multiple organs, 1 including the lacrimal gland, sali vary gland, pancreas, bile duct, liver, kidney, and retroperitoneum. [2][3][4] The main clinical features are elevated serum IgG4 level and IgG4-positive lymphocyte infiltration into tissues. IgG4-related hypophysitis (IgG4-RH), which involves the hypothalamus and pituitary gland, accounts for 1.3% of primary hypophysitis.…”

Section: Introductionmentioning

confidence: 99%

Two cases of immunoglobulin G4 (IgG4)-related hypophysitis diagnosed without pituitary biopsy

Nie

et al. 2020

Therapeutic Advances in Endocrinology

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Background: Immunoglobulin G4-related hypophysitis (IgG4-RH) is a rare disease, diagnosis of which typically depends on histopathology following an invasive pituitary biopsy, possibly leading to permanent hypopituitarism. Herein, we report two cases of IgG4-RH with favorable responses to glucocorticoids. One of them was multiple organs involved and treated with glucocorticoids and methotrexate. Methods: We retrospectively review clinical features, radiological images, and treatment of two cases with IgG4-RH. In addition, literature on IgG4-RH was comprehensively reviewed and a new therapeutic strategy for IgG4-RH was provided. Results: A 45-year-old man presented with diabetes insipidus for 6 months. Pituitary magnetic resonance imaging (MRI) indicated thickening of pituitary stalk. His serum IgG4 was 13,500 mg/l and hormonal evaluation revealed isolated growth hormone deficiency. Pituitary biopsy was denied by the patient due to fears of permanent pituitary damage. Treatment with prednisone and methotrexate (MTX) for 1 week led to improvement in sellar images and reduction in IgG4 level. His IGF1 (insulin-like growth factor-1) recovered after a 4-month treatment. The second case is a 43-year-old woman presenting with diabetes insipidus and amenorrhea for 20 months. Her pituitary MRI was similar to the patient above. Her serum IgG4 level was 5980 mg/l and hormonal measurement confirmed isolated hypogonadotropic hypogonadism. After 2 weeks of prednisone, the sellar images improved. After 3 months of treatment, her pituitary MRI was normal, IgG4 level had decreased to near normal range, and menstruation resumed. Literature review found additional patients with IgG4-RH, who were treated successfully without invasive pituitary biopsy in a manner similar to our cases. Therefore, we discuss the necessity of invasive pituitary biopsy for IgG4-RH. Conclusion: For suspected IgG4-RH with pituitary hormone deficiency, biopsy-induced hypopituitarism may be avoided by using diagnostic glucocorticoid treatment. Impaired pituitary hormone secretion may be recovered in response to steroid therapy. Improved pituitary MRI after 1–2 weeks of glucocorticoid treatment may provide diagnostic evidence of IgG4-RH.

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Clivus Inflammatory Pseudotumor Associated with Immunoglobulin G4-Related Disease

Cited by 15 publications

References 23 publications

Treatment-responsive case of focal clivus IgG4-related hypertrophic pachymeningitis mimicking meningioma; case report

Treatment-responsive case of focal clivus IgG4-related hypertrophic pachymeningitis mimicking meningioma; case report

The Current State of Radiomics for Meningiomas: Promises and Challenges

Two cases of immunoglobulin G4 (IgG4)-related hypophysitis diagnosed without pituitary biopsy

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