RE: Appendiceal Immunoglobulin G4-Related Disease Mimicking Appendiceal Tumor or Appendicitis: A Case Report

Kwon, Dong Hyang; Kallakury, Bhaskar

doi:10.3348/kjr.2017.18.6.1012

Cited by 3 publications

(4 citation statements)

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“…8 However, the authors stated the absence of more specific and diagnostic histopathologic, such as obliterative phlebitis and storiform fibrosis. 10 Similarly in 2018, Veerankutty et al briefly described an appendiceal lesion that mimicked a mucocel on computed tomography scan, but the histology revealed patchy lymphoplasmacytic infiltration and storiform pattern of fibrosis 9 but lacking obliterative phlebitis. The International Committee stated that in the absence of other histologic and clinical findings, IgG4 to IgG ratio alone is insufficient to make diagnosis of IgG4-RD.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there are only 3 cases that describe a mass-forming lesion with increased IgG4 plasma cells in the appendix, 7-9 but none of the cases fulfill all 3 histologic criteria. 10…”

Section: Introductionmentioning

confidence: 99%

“…A portion of this article has been published in the Korean Journal of Radiology as a letter to the editor. 10…”

Section: Introductionmentioning

confidence: 99%

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IgG4-Related Appendiceal Disease: A First Case Report Fulfilling All Pathological Diagnostic Criteria and With Concomitant S100-Positive Dendritic/Schwann Cell Hyperplasia

et al. 2019

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IgG4-related disease is a recent entity that has been described in a wide variety of organ systems. A 46-year-old female presented with acute appendicitis accompanied by a mass-forming lesion, raising a concern for neoplasm, and therefore, hemicolectomy was performed. The lesion revealed a dense lymphoplasmacytic infiltrate accompanied by storiform fibrosis and obliterative phlebitis. The IgG4/IgG plasma cell ratio was >50%, and the number of IgG4-positive plasma cells was >100/high-power field. In order to assess the IgG4/IgG plasma cell ratio, MUM1 was employed instead of IgG to successfully estimate the plasma cell concentration. There was also a concomitant hyperplasia of S100-positive cell, which could represent dendritic or Schwannian origin and possibly play a pathophysiologic role. The hyperplasia was significant by itself that it may mimic a mass-forming lesion. This newly described entity of the past decade deserves increased recognition due to clinical implication and surgical morbidity. This is the first case of IgG4-related disease in the appendix to our knowledge that fully satisfied all the pathological diagnostic criteria. We would like to also highlight our innovative approach of evaluating the IgG4/IgG plasma cell.

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Section: Discussionmentioning

confidence: 99%

“…Currently, there are only 3 cases that describe a mass-forming lesion with increased IgG4 plasma cells in the appendix, 7-9 but none of the cases fulfill all 3 histologic criteria. 10…”

Section: Introductionmentioning

confidence: 99%

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IgG4-Related Appendiceal Disease: A First Case Report Fulfilling All Pathological Diagnostic Criteria and With Concomitant S100-Positive Dendritic/Schwann Cell Hyperplasia

et al. 2019

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“…A. Harada Є повідомлення про випадки IgG4-АЗ з ураженням ілеоцекальної ділянки (і утворенням, що викликає непрохідність) [1] та з ураженням апендикса, що імітує хворобу Крона, апендицит або пухлину апендикса [12,28,32]. Однак лише у кількох цих випадках було визначено s-IgG4, а клінічні, макроскопічні та мікроскопічні ознаки значно перекривалися запальним захворюванням кишечнику (ЗЗК).…”

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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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Non-neoplastic Diseases of Appendix

Said

2019

Surgical Pathology of Non-Neoplastic Gastrointestinal Diseases

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RE: Appendiceal Immunoglobulin G4-Related Disease Mimicking Appendiceal Tumor or Appendicitis: A Case Report

Cited by 3 publications

References 2 publications

IgG4-Related Appendiceal Disease: A First Case Report Fulfilling All Pathological Diagnostic Criteria and With Concomitant S100-Positive Dendritic/Schwann Cell Hyperplasia

IgG4-Related Appendiceal Disease: A First Case Report Fulfilling All Pathological Diagnostic Criteria and With Concomitant S100-Positive Dendritic/Schwann Cell Hyperplasia

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

Non-neoplastic Diseases of Appendix

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