Imaging and pathological features of gastric lesion of immunoglobulin G4-related disease: A case report and review of the recent literature

Inoue, Dai; Yoneda, Norihide; Yoshida, Kotaro; Nuka, Hiromi; Koyama, Jun; Fushida, Sachio; Toshima, Fumihito; Minami, Tetsuya; Takahira, Masayuki; Hamaoka, Shoko; Ikeda, Hiroko; Gabata, Toshifumi; Kawano, Mitsuhiro

doi:10.1080/14397595.2016.1209819

Cited by 13 publications

(11 citation statements)

References 33 publications

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“…Because it is difficult to diagnose clinically, especially in isolated cases, most of the reported patients have undergone surgery. Because this disease involves a submucosal lesion in the stomach, these cases are often misdiagnosed as GIST [3,7,18,19] and are difficult to diagnose on endoscopic forceps biopsy, similar to our cases. Gastric lesions that have been mistaken for GIST or gastric cancer have been reported in the literature (Table 1) [3,[6][7][8][9][10][11][12][13][14][15].…”

Section: Discussionsupporting

confidence: 70%

“…Patients with biliary or pancreatic lesion can present with jaundice, weight loss, and vague abdominal pain. The disease can be an incidental finding during radiological examination and can be mistaken for malignancy, as there are no specific radiological features characteristic of this disease [18,19]. Most cases of gastric IgG4-RD have been reported in middle-aged patients, and both men and women are affected [3,6].…”

Section: Discussionmentioning

confidence: 99%

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Gastric IgG4-related disease presenting as a mass lesion and masquerading as a gastrointestinal stromal tumor

Ramakrishna¹,

Yewale²,

Vijayakumar³

et al. 2020

J Pathol Transl Med

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IgG4-related disease of the stomach is a rare disorder, and only a few cases have been reported. We present two cases that were identified over a 2-month period in our center. Two male patients aged 52 and 48 years presented with mass lesion in the stomach, which were clinically thought to be gastrointestinal stromal tumor, and they underwent excision of the lesion. Microscopic examination revealed marked fibrosis, which was storiform in one case, associated with diffuse lymphoplasmacytic infiltration and an increase in IgG4positive plasma cells on immunohistochemistry. Serum IgG4 level was markedly elevated. Although rare, IgG4-related disease should be considered in the differential diagnosis of gastric submucosal mass lesions.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Gastric IgG4-related disease presenting as a mass lesion and masquerading as a gastrointestinal stromal tumor

Ramakrishna¹,

Yewale²,

Vijayakumar³

et al. 2020

J Pathol Transl Med

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“…The radiologic and pathologic features of submucosal involvement or wall thickening can be typical manifestations of IgG4-related gastric lesions. 76 Diffuse lymphoplasmacytic infiltration in the lamina propria and increased IgG4/IgG ratio in the gastric mucosa (notably in the lower lamina propria) may be characteristic findings of IgG4-related gastritis. 77…”

Section: Other Gastrointestinal Manifestationsmentioning

confidence: 99%

Gastrointestinal and Extra-Intestinal Manifestations of IgG4–Related Disease

et al. 2018

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IgG4-related disease (IgG4-RD) is a chronic relapsing multi-organ fibro-inflammatory syndrome of presumed autoimmune etiology. It is characterized by increased serum levels of IgG4 and tissue infiltration by IgG4 cells. Increased titers of autoantibodies against a spectrum of self-antigens and response to steroids have led to its characterization as an autoimmune disease. However, the pathognomonic antigens probably differ among manifestations, and different antigens or autoantibodies produce similar immune reactions in different organs. Little is known about the pathogenic effects, if any, of serum IgG4 or IgG4 plasma cells in tissues. Despite several animal models of the disease, none truly recapitulates human IgG4-RD. Histologic analyses of tissues from patients with IgG4-RD reveal a dense lymphoplasmacytic infiltrate rich in IgG4 plasma cells, storiform fibrosis, and obliterative phlebitis, although these features vary among organs. Typical presentation and imaging findings include mass-forming synchronous or metachronous lesions in almost any organ, but most commonly in the pancreas, bile duct, retroperitoneum, kidneys, lungs, salivary and lacrimal glands, orbit, and lymph nodes. In all organs, inflammation can be reduced by corticosteroids and drugs that deplete B cells, such as rituximab. Patients with IgG4-RD have relapses that respond to primary therapy. Intense fibrosis accompanies the inflammatory response, leading to permanent organ damage and insufficiency. Death from IgG4-RD is rare. IgG4-RD is a multi-organ disease with predominant pancreatico-biliary involvement. Despite its relapsing-remitting course, patients have an excellent prognosis.

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“…Aunque existen varias publicaciones, reportes de caso [8][9][10][11][12][13][14][15][16] , el compromiso gástrico es de excepción, siendo nuestro caso el primero descrito en a IgG4. La imagen radiológica mostró marcado engrosamiento de la pared gástrica, con distensibilidad disminuida en la endoscopia, confirmando un compromiso más allá de la mucosa, que incluía las capas musculares.…”

Section: B a Figura 2 A-bunclassified

“…En nuestra experiencia, el compromiso más frecuentemente asociado a la PAI tipo 1 es a nivel de glándulas salivales y conductos biliares 7 , siendo extremadamente raro el compromiso gástrico. A este nivel, se han reportado desde casos esporádicos con úlceras, lesiones polipoideas, masas submucosas y engrosamiento parietal [8][9][10][11][12][13][14][15] , hasta manifestaciones morfológicas y clínicas de síndrome de Ménétrier 16 . Otros también han descrito compromiso de la papila de Vater, demostrando papilitis con infiltración por linfoplasmocitos IgG4 positivos 17,18 .…”

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Gastropatía hipertrófica por IgG4. Reporte del primer caso en Chile

et al. 2019

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IgG4 related hypertrophic gastropathy. Report of one caseIgG4 related disease is a systemic autoimmune disease, which can affect different organs. The most common digestive manifestation is autoimmune pancreatitis (AIP), followed by involvement of bile ducts and the major papilla. The stomach is only rarely involved. We report a 71-year-old diabetic woman consulting for jaundice and weight loss. Abdominal CAT scan, cholangio resonance imaging, endosonography and a serum IgG4 of five times the normal value, lead to the diagnosis of an autoimmune pancreatitis. An upper gastrointestinal endoscopy showed a diffuse thickening of gastric folds. The pathological study confirmed the presence of IgG4 positive plasma cells. The patient was successfully treated with steroids.

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Imaging and pathological features of gastric lesion of immunoglobulin G4-related disease: A case report and review of the recent literature

Cited by 13 publications

References 33 publications

Gastric IgG4-related disease presenting as a mass lesion and masquerading as a gastrointestinal stromal tumor

Gastric IgG4-related disease presenting as a mass lesion and masquerading as a gastrointestinal stromal tumor

Gastrointestinal and Extra-Intestinal Manifestations of IgG4–Related Disease

Gastropatía hipertrófica por IgG4. Reporte del primer caso en Chile

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