Immunoglobulin G4–Related Lymphadenopathy

Bookhout, Christine; Rollins‐Raval, Marian A.

doi:10.1016/j.path.2015.09.005

Cited by 18 publications

(12 citation statements)

References 47 publications

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“…AIP has been reported in the literature to involve other abdominal organs, including the mesentery, abdominal lymph nodes, prostate, stomach and liver [ 39 , 50 , 51 ]. Involvement of these systems is very rare, and imaging features include soft-tissue masses that demonstrate PET avidity.…”

Section: Imaging Findingsmentioning

confidence: 99%

Abdominal manifestations of IgG4-related disease: a pictorial review

2018

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In the last decade, autoimmune pancreatitis has become recognised as part of a wider spectrum of IgG4-related disease, typically associated with elevated serum IgG4 levels and demonstrating a response to corticosteroid therapy. Radiologically, there is imaging overlap with other benign and neoplastic conditions. This pictorial review discusses the intra-abdominal manifestations of this disease on cross-sectional imaging before and after steroid treatment and the main radiological features which help to distinguish it from other key differentials.Teaching Points• Autoimmune pancreatitis is part of a spectrum of IgG4-related disease.• Diagnosis is based on raised serum IgG4, clinical, radiological and histopathological findings.• Cross-sectional imaging can demonstrate the typical findings of abdominal IgG4-related disease.• Cross-sectional imaging can be used to monitor response to corticosteroid treatment.

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Section: Imaging Findingsmentioning

confidence: 99%

Abdominal manifestations of IgG4-related disease: a pictorial review

2018

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“…Both the original International Consensus Criteria(2) and the recent 2019 EULAR/ACR criteria (6) are designed to help exclude mimickers of IgG4-RD such as cancer, vasculitis, and rare conditions such as multi-centric Castleman disease. The importance of timely diagnosis of IgG4-RD has been amply highlighted in literature with numerous case studies and reviews, whereby the initial malignancy diagnosis can lead to delayed initiation of medical treatment, and in some cases, major surgical resections (3,5,(7)(8)(9). Due to the tumefactive nature of the disease, it can share striking similar presentations and characteristics to malignancy, resulting in the differentiation of the two complicated in many patients.…”

Section: Discussionmentioning

confidence: 99%

“…Since the discovery of IgG4-RD in the early 2000's, its differentiation from malignant causes of tumefactive lesions has been a di cult problem for clinicians and radiologists. There are numerous case reports of IgG4-RD presenting as mass lesions and being mistaken for malignancy in organs such as pancreas, lung, mediastinum, and gallbladder (7)(8)(9). The discovery of IgG4-related pancreatitis was driven largely by the fact that many patients were undergoing potentially unnecessary Whipple's resections only to nd that they had autoimmune pancreatitis, which is treatable with medical therapy, rather than pancreatic cancer (5).…”

Section: Introductionmentioning

confidence: 99%

IgG4-Related Disease as Mimicker of Malignancy

Zhou

Murray

Cartagena

et al. 2020

Preprint

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Background: IgG4-related disease 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 unnecessary surgical resection. We performed a retrospective single center study examining how many patients with IgG4-RD were initially believed to havemalignancy,with particular attention to those who underwent potentially avoidable surgical procedures. Methods: 63 patients with biopsy confirmed IgG4-Related Disease based on International Consensus Criteria 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 malignancywhen 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.

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“…Colchicine is a major drug that sine qua non in the treatment of FMF. However, anti-interleukin-1 agents are recommended in colchicine resistant and/or intolerant FMF patients (2). Objectives: The aim of this study is to evaluate the efficacy of anti-interleukin-1 (anti-IL-1) agents in 54 FMF patients with resistant/intolareted to colchicine or complicated with amyloidosis.…”

Section: Experience Of Anakinra and Canakinumab In Patients With Colcmentioning

confidence: 99%

Thu0584 rheumatological Immune-Related Adverse Events Associadted With Immunotherapy in Solid Organ Tumor. Study of 102 Cases From a Referral Single Center for Last 4 Years

Bilbao

González-Mazón

Demetrio‐Pablo

et al. 2019

Poster Presentations

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BackgroundImmune checkpoint blockade therapy (ICBT) currently is one of the most used therapies against cancer. The activation of the immune system can lead to different immune-related adverse events (irAEs), being the rheumatological side effects among the most common.ObjectivesOur aim was to assess the rheumatological irAEs in patients who received immunotherapy.MethodsWe set up an observational study of patients treated with Nivolumab and Pembrolizumab (anti-PD1), Atezolizumab (anti-PD-L1) and Ipilimumab (antiCTLA-4) for solid organ tumors. All these patients were followed in a single reference University Hospital from March-2015 up to December-2018. The main outcome was to determinate the incidence of rheumatological irAEs.ResultsWe studied 102 patients (63♂/39♀) with a mean age of 60.6±9.7 with different solid organ tumors. Only 7 patients (6.8%) had a previous diagnosis of an immune-mediated disease: psoriasis (n=2), psoriatic arthritis (1), systemic lupus erythematosus (1), spondyloarthitis (1), rheumatoid arthritis (1) and skin lupus (1).Rheumatological side effects were observed in 15 patients (14.7%): inflammatory arthralgia (8), arthritis (6), myositis (2) and aortitis (1). The time of appearance of the rheumatological irAEs was of 6.36 months (±5.81). From the 7 patients with previous diagnosis of an immune-mediated disease, only 1 patient with psoriasis suffered a worsening of skin symptoms and another one with psoriatic arthritis had a monoarthritis episode.Among the 14 patients who suffered from arthralgia/arthritis, the most frequent pattern was oligoarticular (40%), followed by poly (30%) and monoarticular (30%). The most affected joint was the knee (n=4), followed by wrist (3), hands (3), ankle (2), shoulder (2) and foot (1).Apart from the articular disease, 2 patients suffered from myositis in lower limbs, with weakness of legs and arthralgia in their knees. A patient was diagnosed of aortitis through a PET, although the patient did not have any symptom.Immunology tests with RF, ACCP and ANA were done in 8 out of the 15 patients with musculoskeletal irAEs, being negative in all cases.Interviewing 40 of the patients who received ICBT, 7 of them (17.5%) referred xerophthalmia. 6 of them (15%) had a positive Schrimer test, and 3 (7.5%) had a reduced tear break-up time. None patient met Sjögren criteria.In 6 out of the 15 patients with rheumatological irAEs (all of them with arthralgia/arthritis) the ICBT was removed, temporary in all cases, and could be reintroduced after a mean of 33 ± 18.9 days. 6 patients were treated with NSAIDs and 5 with oral prednisone (2 of them also required intra-articular corticoids).ConclusionRheumatological irAEs are common in clinical practice. Arthralgia-Arthritis and dry-syndrome are the most frequent adverse events.Disclosure of InterestsLara Sánchez Bilbao: None declared, Iñigo González-Mazón: None declared, Rosalía Demetrio-Pablo: None declared, José Luis Martín-Varillas: None declared, Marina Delgado Ruiz: None declared, Isabel Bernat Piña: None declared, Belén ...

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Immunoglobulin G4–Related Lymphadenopathy

Cited by 18 publications

References 47 publications

Abdominal manifestations of IgG4-related disease: a pictorial review

Abdominal manifestations of IgG4-related disease: a pictorial review

IgG4-Related Disease as Mimicker of Malignancy

Thu0584 rheumatological Immune-Related Adverse Events Associadted With Immunotherapy in Solid Organ Tumor. Study of 102 Cases From a Referral Single Center for Last 4 Years

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