Korean J Gastroenterol.  2012 Oct;60(4):258-261. 10.4166/kjg.2012.60.4.258.

A Case of Intraperitoneal Immunoglobulin G4-related Inflammatory Pseudotumor

• Moh IH
• Kim JB
• Shin SR
• Jung SW
• Park SH
• Kim JW
• Shin MK
• Lee MS

• KMID: 1775811
• DOI: http://doi.org/10.4166/kjg.2012.60.4.258

Abstract

The term inflammatory pseudotumor (IPT) has been used to describe inflammatory and fibrosing tumoral processes of an undetermined cause that may involve a variety of organ system. IgG4-related disease is a newly recognized fibroinflammatory condition characterized by IgG4-producing plasma cell expansion in affected organs and, often but not always, elevated serum IgG4 concentrations. IgG4-related IPTs, a subtype of IPT, are characterized by dense infiltration of IgG4-positive plasma cells and stromal fibrosis. The association between inflammatory pseudotumor and IgG4 was first reported with a regard to sclerosing pancreatitis. Despite there are many reports on intraperitoneal IPTs including both cellular and lymphoplasmacytic type, only a few cases have been confirmed to be IgG4-related. We experienced a case of intraperitoneal IgG4-related inflammatory pseudotumor in an 83-year-old woman presenting with epigastric pain and malaise. Surgical specimens revealed an IgG4-related inflammatory pseudotumor.

Keyword

IgG4-related disease; Immunoglobulin G4; Inflammatory pseudotumor; Intraperitoneal tumor

MeSH Terms

Aged, 80 and over
C-Reactive Protein/analysis
Female
Granuloma, Plasma Cell/*diagnosis/pathology/surgery
Humans
Immunoglobulin G/*blood
Plasma Cells/metabolism
Positron-Emission Tomography
Tomography, X-Ray Computed

Figure

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  Fig. 1 CT with contrast enhancement. An 11×8 cm sized well defined heterogenous mass adjacent to the stomach was noted.

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  Fig. 2 Gross specimen. The well circumscribed mass measured 10.5×6.5×3.5 cm.

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  Fig. 3 Histologic features of the resected specimen. (A) The lymphoplasmacytic infiltrate showed the formation of germinal centers (H&E, ×200). High-power view showed an admixture of spindle-shaped cells and prominent lymphoplasma cells within fibrotic stroma (inset, H&E, ×400). (B) Immunohistochemical staining of IgG4. Up to 25/HPF IgG4 positive plasma cells were noted (×400).

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