Immunoglobulin G4-related cholecystitis mimicking a locally advanced gallbladder cancer—a case report and review of literature

Jearth, Vaneet; Patil, Prachi; Patkar, Shraddha; Goel, Mahesh; Mehta, Shaesta; Deodhar, Kedar; Rao, Vidya

doi:10.1007/s12328-020-01168-7

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…One presented with asymmetrical wall thickening and the other with gall bladder mass. IgG4 has been reported earlier also as a mimicker of carcinoma gall bladder [26][27][28]. Two of the benign cases were tuberculosis in our series.…”

Section: Discussionsupporting

confidence: 72%

Misdiagnosis of carcinoma gall bladder in endemic regions

et al. 2022

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Background Incidental carcinoma gall bladder and benign disease in radical cholecystectomy specimen is the cause of concern. We attempted to find out the incidence and reasons thereof in the present study. Methods Present study is a retrospective analysis of a prospectively maintained database between July 2002 and July 2019. All patients with a diagnosis of carcinoma gall bladder admitted for surgery were included. Results Out of 148 patients, 110 patients had carcinoma gall bladder (CAGB), while 38 patients (25.7%) had incidental carcinoma (under-diagnosis). Radical resection was done in 61/110 (55.4%) patients with clinical CAGB, where 15 (24.6%) patients had benign pathology (“over-diagnosis”). Overdiagnosis was due to xanthogranulomatous cholecystitis (n = 9), chronic cholecystitis (n = 2), tuberculosis (n = 2) and IgG4 related cholecystitis (n = 2). Among 61 patients, a history of weight loss and anorexia were significantly associated with malignancy. Asymmetrical wall thickness was significantly more common in benign mimickers. Among patients with incidental carcinoma, preoperative ultrasonography reported normal wall thickness of gall bladder in 28 (73.7%), thickened gall bladder wall in 6, and polyp in 3 patients. The resectability rate among incidental carcinoma was 27/38 (71.05%). Conclusion Over-diagnosis of the carcinoma gall bladder was present in 24.6%. On the other hand, incidental carcinoma comprised 25.7% of all admissions for carcinoma gall bladder with resectability of 71%.

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Section: Discussionsupporting

confidence: 72%

Misdiagnosis of carcinoma gall bladder in endemic regions

et al. 2022

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“…The two-layer type is frequently observed in cases with an enlarged and significantly wall-thickened gallbladder. In the two-layer type, the almost normal mucosa with normal contrast enhancement (CE) or thickened mucosa with CE forms the inner layer with/without lymphoplasmacytic infiltrate and fibrosis; thickened "MP" and "SS" (and 'S') form the outer layer with almost no CE and lymphoplasmacytic infiltrate and fibrosis, whose typical pictures are shown in Figure 2 and are described in the reports by Leise et al [22] and Jearth et al [29]. In the one-layer type, "M", "MP", and "SS" (and "S") form a smoothly thickened wall with CE reflecting lymphoplasmacytic infiltrate and fibrosis, whose typical pictures are shown in Figures 3 and 4 and are described in the reports by Matsubayashi et al [14] and Li et al [17].…”

Section: Diffuse Type Of Igg4-ccmentioning

confidence: 84%

“…According to our search with keywords "IgG4" or "immunoglobulin-4" and "cholecystitis", or "gallbladder" on PubMed (1980 to May 2021), there have been 47 cases of IgG4-related sclerosing cholecystitis (IgG4-CC) with some information, including 9 cases of IgG4-CC with AIP (Table 1) and 11 cases of IgG4-CC without AIP (Table 2) that have sufficient clinical information [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. The patient characteristics of the 47 cases are as follows: male/female ratio of 32/14 (unknown 1), mean age of 57.4, patients with/without autoimmune pancreatitis ratio of 15/11 (unknown 21), patients with/without gallbladder stone ratio of 11/28 (2 sludge and 6 unknown 6, and an average serum IgG4 level of 489.6 mg/dL in 14 cases (not assessed in 33 cases).…”

Section: Clinical Features Of Igg4-related Sclerosing Cholecystitismentioning

confidence: 99%

Clinical and Image Characteristics of IgG4-Related Sclerosing Cholecystitis

Kuwatani

Sakamoto

2021

Diagnostics

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Since autoimmune pancreatitis (AIP) was established as a new disease entity, sclerosing change with abundant immunoglobulin-4 (IgG4)-positive plasma cells, storiform fibrosis, and obliterative phlebitis are main pathological features in IgG4-related diseases. Regarding IgG4-related sclerosing cholecystitis (IgG4-CC), which is occasionally associated with AIP cases and is rarely isolated, there are no diagnostic criteria and insufficient perceptions of the image findings. Although there have been some reports on IgG4-CC, differentiation between IgG4-CC and gallbladder cancer is very difficult in some cases with a localized lesion. In this review, we especially focused on image findings of IgG4-CC and summarized its image features for diagnostic assistance. The ultrasonography and CT findings of IgG4-CC could be classified into diffuse and localized types. Based on these findings, the presence of wall thickening with an intact or smooth mucosal layer, followed by a homogenously thickened outer layer, would be a helpful morphological finding to distinguish IgG4-CC from gallbladder cancer.

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“…A PubMed search for past case reports from January 2005 to August 2021 using the search term "IgG4-related cholecystitis" retrieved 16 cases (Table 1 ) [ 5 – 9 , 16 – 24 ]. Six of 17 cases showed diffuse wall thickening, while the remaining 11 cases (including our case) presented with localized thickening.…”

Section: Discussionmentioning

confidence: 99%

Isolated IgG4-related cholecystitis with localized gallbladder wall thickening mimicking gallbladder cancer: a case report and literature review

et al. 2022

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Background IgG4-related cholecystitis, which is a manifestation of IgG4-related disease in the gallbladder, is associated with autoimmune pancreatitis or IgG4-related sclerosing cholangitis in most cases; isolated gallbladder lesions without systemic manifestations are very rare. Gallbladder wall thickening is often diffuse, but sometimes localized, in which case, differentiation from gallbladder cancer becomes difficult. The characteristic features of IgG4-related cholecystitis on imaging that would enable differentiation from gallbladder cancer remain poorly described. Case presentation We present a rare case of isolated IgG4-related cholecystitis with localized gallbladder wall thickening that was clinically difficult to distinguish from malignancy before resection. An 82-year-old man was referred to our hospital because of gallbladder wall thickening on abdominal ultrasonography without any symptoms. Dynamic computed tomography of the abdomen showed localized wall thickening from the body to the fundus of the gallbladder that was enhanced from an early stage with a prolonged contrast effect. There were no other findings, such as pancreatic enlargement and bile duct dilatation. Magnetic resonance cholangiopancreatography revealed neither dilatation nor stenosis of the bile duct and pancreatic duct. Endoscopic ultrasonography (EUS) showed a smooth layered thickening of the gallbladder wall with a maximum thickness of 6 mm and a well-preserved outermost hyperechoic layer in the same area. Laparoscopic cholecystectomy was performed because malignancy could not be completely ruled out. Pathological examination of a resected specimen revealed IgG4-positive plasma cell infiltration, fibrosis, and phlebitis. Although the serum IgG4 level measured after resection was normal, the condition was ultimately diagnosed as probable IgG4-related cholecystitis according to the 2020 revised comprehensive diagnostic criteria for IgG4-related disease. The EUS images reflected the pathological findings, in which lymphocytic infiltration was distributed in a laminar fashion in the gallbladder wall. Conclusions Although rare, isolated IgG4-related cholecystitis with localized wall thickening mimicking gallbladder cancer remains a clinical problem. A smooth laminar thickening of the gallbladder wall on EUS imaging could be one of the most informative characteristics for differentiating IgG4-related cholecystitis from gallbladder cancer.

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Immunoglobulin G4-related cholecystitis mimicking a locally advanced gallbladder cancer—a case report and review of literature

Cited by 5 publications

References 12 publications

Misdiagnosis of carcinoma gall bladder in endemic regions

Misdiagnosis of carcinoma gall bladder in endemic regions

Clinical and Image Characteristics of IgG4-Related Sclerosing Cholecystitis

Isolated IgG4-related cholecystitis with localized gallbladder wall thickening mimicking gallbladder cancer: a case report and literature review

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