IgG4-related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery: a case report
Abstract Background IgG4-related disease (IgG4-RD) is an immune-mediated disorder in which abundant IgG4-positive plasma cells infiltrate affected organs. There have been reported four cases of probable IgG4-RD presenting as a submucosal tumor of the stomach. We herein report the first case of defin...
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Japan Surgical Society
2020-05-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00851-8 |
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| author | Taishi Yamane Kojiro Eto Takeshi Morinaga Kazuki Matsumura Kohei Yamashita Ryuma Tokunaga Kazuto Harada Yukiharu Hiyoshi Yohei Nagai Masaki Iwatsuki Shiro Iwagami Yuji Miyamoto Naoya Yoshida Hideo Baba |
| author_facet | Taishi Yamane Kojiro Eto Takeshi Morinaga Kazuki Matsumura Kohei Yamashita Ryuma Tokunaga Kazuto Harada Yukiharu Hiyoshi Yohei Nagai Masaki Iwatsuki Shiro Iwagami Yuji Miyamoto Naoya Yoshida Hideo Baba |
| author_sort | Taishi Yamane |
| collection | DOAJ |
| description | Abstract Background IgG4-related disease (IgG4-RD) is an immune-mediated disorder in which abundant IgG4-positive plasma cells infiltrate affected organs. There have been reported four cases of probable IgG4-RD presenting as a submucosal tumor of the stomach. We herein report the first case of definite IgG4-RD presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery (LECS). Case presentation A 70-year-old woman with a 6-year history of autoimmune pancreatitis was referred to our department because a 15-mm submucosal tumor in the greater curvature of the lower part of the stomach had been identified via upper gastrointestinal endoscopy. Endoscopic ultrasonography showed a 10-mm low-echoic lesion derived from the submucosal layer of the stomach. A fine-needle aspiration biopsy was attempted, but the tumor was too hard for sampling. F-fluorodeoxyglucose (FDG) positron emission tomography showed an FDG uptake, suggesting a possibility of malignant disease. As the diagnosis could not be confirmed, LECS for both the diagnosis and curative treatment was performed. A histopathological examination showed a tumor with IgG4-positive lymphoplasmacytic infiltration and fibrosis. The ratio of IgG4+/IgG+ lymphoplasmacytic cells was > 80%. A laboratory examination showed elevation of the serum IgG4 levels preoperatively. Thus, the final diagnosis was IgG4-RD of the stomach. No recurrence was observed within 1 year after surgery. Conclusions We encountered a case of definite IgG4-RD presenting as a gastric SMT in which a correct diagnosis was achieved by a minimally invasive LECS technique. IgG4-RD may present as a gastric lesion and should be taken into consideration as a differential diagnosis. |
| format | Article |
| id | doaj-art-4cd94fef9ab44b22aa27fd2969260a0b |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-05-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-4cd94fef9ab44b22aa27fd2969260a0b2025-08-20T02:52:49ZengJapan Surgical SocietySurgical Case Reports2198-77932020-05-01611410.1186/s40792-020-00851-8IgG4-related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery: a case reportTaishi Yamane0Kojiro Eto1Takeshi Morinaga2Kazuki Matsumura3Kohei Yamashita4Ryuma Tokunaga5Kazuto Harada6Yukiharu Hiyoshi7Yohei Nagai8Masaki Iwatsuki9Shiro Iwagami10Yuji Miyamoto11Naoya Yoshida12Hideo Baba13Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto UniversityAbstract Background IgG4-related disease (IgG4-RD) is an immune-mediated disorder in which abundant IgG4-positive plasma cells infiltrate affected organs. There have been reported four cases of probable IgG4-RD presenting as a submucosal tumor of the stomach. We herein report the first case of definite IgG4-RD presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery (LECS). Case presentation A 70-year-old woman with a 6-year history of autoimmune pancreatitis was referred to our department because a 15-mm submucosal tumor in the greater curvature of the lower part of the stomach had been identified via upper gastrointestinal endoscopy. Endoscopic ultrasonography showed a 10-mm low-echoic lesion derived from the submucosal layer of the stomach. A fine-needle aspiration biopsy was attempted, but the tumor was too hard for sampling. F-fluorodeoxyglucose (FDG) positron emission tomography showed an FDG uptake, suggesting a possibility of malignant disease. As the diagnosis could not be confirmed, LECS for both the diagnosis and curative treatment was performed. A histopathological examination showed a tumor with IgG4-positive lymphoplasmacytic infiltration and fibrosis. The ratio of IgG4+/IgG+ lymphoplasmacytic cells was > 80%. A laboratory examination showed elevation of the serum IgG4 levels preoperatively. Thus, the final diagnosis was IgG4-RD of the stomach. No recurrence was observed within 1 year after surgery. Conclusions We encountered a case of definite IgG4-RD presenting as a gastric SMT in which a correct diagnosis was achieved by a minimally invasive LECS technique. IgG4-RD may present as a gastric lesion and should be taken into consideration as a differential diagnosis.http://link.springer.com/article/10.1186/s40792-020-00851-8Submucosal tumor of the stomachIgG4-related disease (IgG4-RD)Laparoscopic endoscopic cooperative surgery (LECS) |
| spellingShingle | Taishi Yamane Kojiro Eto Takeshi Morinaga Kazuki Matsumura Kohei Yamashita Ryuma Tokunaga Kazuto Harada Yukiharu Hiyoshi Yohei Nagai Masaki Iwatsuki Shiro Iwagami Yuji Miyamoto Naoya Yoshida Hideo Baba IgG4-related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery: a case report Surgical Case Reports Submucosal tumor of the stomach IgG4-related disease (IgG4-RD) Laparoscopic endoscopic cooperative surgery (LECS) |
| title | IgG4-related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery: a case report |
| title_full | IgG4-related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery: a case report |
| title_fullStr | IgG4-related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery: a case report |
| title_full_unstemmed | IgG4-related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery: a case report |
| title_short | IgG4-related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery: a case report |
| title_sort | igg4 related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery a case report |
| topic | Submucosal tumor of the stomach IgG4-related disease (IgG4-RD) Laparoscopic endoscopic cooperative surgery (LECS) |
| url | http://link.springer.com/article/10.1186/s40792-020-00851-8 |
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