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Inoue K, Okubo T, Kato T, Shimamura K, Sugita T, Kubota M, Kanaya K, Yamachika D, Sato M, Inoue D, Harada K, Kawano M. IgG4-related stomach muscle lesion with a renal pseudotumor and multiple renal rim-like lesions: A rare manifestation of IgG4-related disease. Mod Rheumatol 2015; 28:188-192. [DOI: 10.3109/14397595.2015.1081743] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Koichi Inoue
- Division of Surgery, Yamachika Memorial Hospital, Odawara, Kanagawa, Japan,
| | - Takehiko Okubo
- Division of Internal Medicine, Yamachika Memorial Hospital, Odawara, Kanagawa, Japan,
| | - Takashi Kato
- Division of Rheumatology, Yamachika Memorial Hospital, Odawara, Kanagawa, Japan,
| | - Kazuo Shimamura
- Division of Pathology, Yamachika Memorial Hospital, Odawara, Kanagawa, Japan,
| | - Teruji Sugita
- Division of Surgery, Yamachika Memorial Hospital, Odawara, Kanagawa, Japan,
| | - Mitsuhiro Kubota
- Division of Surgery, Yamachika Memorial Hospital, Odawara, Kanagawa, Japan,
| | - Kohji Kanaya
- Division of Surgery, Yamachika Memorial Hospital, Odawara, Kanagawa, Japan,
| | - Daisuke Yamachika
- Division of Surgery, Yamachika Memorial Hospital, Odawara, Kanagawa, Japan,
| | - Makoto Sato
- Division of Surgery, Yamachika Memorial Hospital, Odawara, Kanagawa, Japan,
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan,
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan, and
| | - Mitsuhiro Kawano
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan
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IgG4-related tubulointerstitial nephritis accompanied with cystic formation. BMC Urol 2014; 14:54. [PMID: 25038818 PMCID: PMC4107474 DOI: 10.1186/1471-2490-14-54] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/09/2014] [Indexed: 12/24/2022] Open
Abstract
Background An immunoglobulin G4 (IgG4)-related disease is important disease in differential diagnosis of tumors in kidney, pancreas, lung and other organs. The imaging findings of IgG4-related kidney diseases are usually expressed as defect contrast region, while cystic formation in kidney is extremely rare. Here, we report a case of IgG4-related tubulointerstitial nephritis with renal cystic change caused by the narrowing or obstruction of collecting duct in renal medulla. Case presentation Abdominal contrasted CT scan showed a 31 × 24 mm cystic tumor at the upper pole of the right kidney and multiple low-attenuation areas in the left kidney. 18 F-fluorodeoxyglucose (FDG)-PET/CT scan showed moderate FDG accumulation of cystic tumor in marginal lesion. In addition, FDG-PET/CT scan also showed moderate FDG accumulation in the pancreatic body. Laparoscopic right nephrectomy was performed. Histological examination was revealed lymphoplasmacytic infiltrate with focal fibrosis and severe narrowing or obstruction of lumen of collecting duct in renal medulla. Furthermore, the IgG4 positive plasma cells infiltrated exceeding 10 cells per one high-power field in renal medulla. The ratio of IgG4-plasma cells to IgG-positive plasma cells was about 50%. The serum level of IgG4 was also elevated (218 mg/dl). Based on these findings, we finally diagnosed IgG4-related tubulointerstitial nephritis with renal cystic change. Conclusion IgG4-related kidney disease might cause cystic formation by severe narrowing and obstruction of collecting duct.
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