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Comi S, Lanzolla G, Cosentino G, Maglionico MN, Posarelli C, Menconi F, Santini F, Elisei R, Marinò M. IgG4 serum levels in Graves' orbitopathy. J Endocrinol Invest 2024; 47:1711-1717. [PMID: 38127192 DOI: 10.1007/s40618-023-02265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE IgG4-related disease (IgG4-RD) can involve many organs, including thyroid and orbital tissues. A link between IgG4, Graves' disease (GD) and Graves' orbitopathy (GO) has been proposed, but results are conflicting. Here we investigated the possible association between IgG4 and GO. METHODS Retrospective investigation in 297 patients with Graves' disease (GD), 152 with GO. PRIMARY OUTCOME prevalence of IgG4 ≥ 135 mg/dL (cut-off for IgG4-RD). SECONDARY OBJECTIVES (1) serum IgG4 concentrations; (2) IgG4/IgG ratio; (3) prevalence of IgG4/IgG ratio ≥ 8.0%; (4) relationship between IgG4 and eye features; (5) relationship between IgG4 and anti-TSH receptor antibodies (TRAbs). RESULTS Because GO patients had lower FT3 concentrations, we evaluated the main objectives in the second and third FT3 quartiles subpopulation, in which there were no relevant differences between patients with (n = 81) or without GO (n = 67) for baseline parameters. Within this population, the prevalence of IgG4 levels ≥ 135 mg/dL did not differ between patients without and with GO (17.9% vs 17.3%). No difference was observed concerning IgG4 concentrations, prevalence of IgG4/IgG ≥ 8.0%, and IgG4/IgG ratio. There was no relationship between IgG4 and eye features and no correlation between IgG4 levels and TRAb was found. CONCLUSIONS Our results suggest that, within GD, there is no relationship between serum IgG4 and GO.
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Affiliation(s)
- S Comi
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - G Lanzolla
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - G Cosentino
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M N Maglionico
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - C Posarelli
- Department of Surgical, Medical and Molecular Pathology, Ophthalmology Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - F Menconi
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - F Santini
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - R Elisei
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - M Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Khan F, Shahid J, Saleem A, Khawaja UA, Memon WA, Zafar U, Hameed TA, Abbasher Hussien Mohamed Ahmed K. IgG4-related inflammatory pancreatic head pseudotumor mirrors pancreatic head tumor: A novel case series with a review of the literature. Clin Case Rep 2024; 12:e8467. [PMID: 38317667 PMCID: PMC10839121 DOI: 10.1002/ccr3.8467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
Key Clinical Message In this noteworthy case series regarding pancreatic pseudo tumors, we intend to spread knowledge among physicians for the diagnostic and therapeutic approach and eventual disease prognosis. Abstract Inflammatory pseudotumor of pancreatic head greatly mimics pancreatic head tumor. One of them is IgG4-related pancreatic disease, which is commonly mistaken as neoplastic disease on imaging. In our novel case series, we report three cases of IgG4-related pancreatic head pseudotumor with patients ranging from 35 to 72 years of age. Patients presented with jaundice and abdominal pain. Alongside initial laboratory workup, abdominal CTs and serum IgG4 levels were also obtained. Imaging features in conjunction with IgG4 levels confirmed the diagnosis of IgG4-related autoimmune pancreatitis. Pancreatic pseudotumors are notorious for being often reported as real tumors. Through our noteworthy case series, we intend to highlight the imaging features and laboratory markers that are crucial in such cases to avoid invasive procedures.
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Affiliation(s)
- Faheemullah Khan
- Department of RadiologyAga Khan University HospitalKarachiPakistan
| | - Jehanzeb Shahid
- Department of RadiologyAga Khan University HospitalKarachiPakistan
| | - Amna Saleem
- Jinnah Medical and Dental CollegeKarachiPakistan
| | | | | | - Uffan Zafar
- Department of RadiologyAga Khan University HospitalKarachiPakistan
| | - Tariq Abdul Hameed
- Department of RadiologyIndiana University School of MedicineIndianapolisIndianaUSA
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3
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Nguyen H, Pham DH, Luong TH. Successful surgical management of an aggressive IgG4-related sclerosing esophageal inflammatory pseudotumor: a case report and review of literature. J Cardiothorac Surg 2023; 18:215. [PMID: 37403075 DOI: 10.1186/s13019-023-02317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/28/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) of the esophagus is a very rare benign lesions which clinical presentation is not clear and difficult to make a definitive diagnosis preoperatively. CASE PRESENTATION In this report, we presented a case of a 24-year-old female with signs of severe malnutrition state due to dysphagia increasing gradually and losing 10 kg in weight for 2 months. Comprehensive preoperative radiologic investigations were proceeded with a circumferential severe stricture caused smooth submucosal swelling in the esophagus under 23 cm from the upper dental arch and two times of negative biopsy. Due to the aggressive clinical symptoms and gross lesion characteristics, the patient underwent laparoscopic-thoracoscopic esophagectomy and reconstruction with a gastric tube. Histopathological examination showed that the squamous epithelium of the esophagus had a small, benign nucleus, the submucosal layer and the smooth muscle layer increased fibrous, with infiltrating many lymphocytes, plasma cells, and macrophages. Immunohistochemical staining was negative for CD68, CD34, Desmin and ALK markers, and there was an increase in the number of IgG4-positive plasma cells. The final diagnosis was an aggressive IgG4-related sclerosing esophageal inflammatory pseudotumor. CONCLUSIONS Inflammatory pseudotumor of the esophagus is an extremely rare benign lesion but could led to aggressive clinical presentation. The gold standard of diagnosis is histopathological examination of surgically removed specimens. Radical resection is still the most efficient treatment method.
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Affiliation(s)
- Hoang Nguyen
- Department of Gastrointestinal and Hepatobiliary surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Surgery, Hanoi Medical University, 1st Ton That Tung Street, Dong Da, Ha Noi, Hanoi, 11521, Vietnam
| | - Duc Huan Pham
- Center for Gastroenterology - Hepatobiliary - Urology - Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Tuan Hiep Luong
- Department of Surgery, Hanoi Medical University, 1st Ton That Tung Street, Dong Da, Ha Noi, Hanoi, 11521, Vietnam.
- Department of Gastrointestinal and Hepato-pancreato-biliary surgery, Bach Mai Hospital, Hanoi, Vietnam.
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4
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Chen S, Zhang H, Fang F, Ye C, Zhang K. Characteristics of mass-forming autoimmune pancreatitis commonly misdiagnosed as a malignant tumor. Front Surg 2023; 10:1017621. [PMID: 36761026 PMCID: PMC9905684 DOI: 10.3389/fsurg.2023.1017621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023] Open
Abstract
Objective This study aimed to explore the clinical characteristics and differential diagnosis of patients with autoimmune pancreatitis (AIP) and pancreatic cancer to prevent misdiagnosis and mistreatment. Methods The clinical data of patients with AIP with suspected pancreatic or bile duct malignancy and pancreatic cancer were retrospectively analyzed. The risk factors and the diagnostic value of IgG4 and Tbil levels before treatment for AIP was investigated. Moreover, the imaging features and response to hormone therapy were analyzed. Results AIP was commonly observed in men. Compared to patients with pancreatic cancer, the incidence of poor appetite and weight loss and carbohydrate antigen 19-9 (CA19-9) level was lower in patients with AIP, while the immunoglobulin G4 (IgG4) level was higher (p < 0.05). After treatment, the IgG4 and CA19-9 levels in patients with AIP were decreased (p < 0.001). IgG4 level before treatment (OR = 2.452, 95%CI: 1.180-5.096, P = 0.016) and total bilirubin (Tbil) level before treatment (OR = 0.992, 95%CI: 0.985-0.998, P = 0.013) were independent risk factors of AIP. Furthermore, the diagnostic value of IgG4 level before treatment, Tbil level before treatment, IgG4/Tbil before treatment, and a combination of these indicators was high. Moreover, 15 (68.18%) patients with AIP had space-occupying lesions of the pancreas, and 16 (72.73%) had autoimmune cholangitis. Most patients with AIP were sensitive to hormone therapy. Conclusions The Tbil and IgG4 levels, imaging findings, and hormone therapy reactivity could differentiate AIP from pancreatic cancer. A combination of IgG4, Tbil, and IgG4/Tbil before treatment might be a promising diagnostic biomarker for AIP.
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Affiliation(s)
- Si Chen
- Department of Gastroenterology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China,Correspondence: Si Chen Kaiguang Zhang
| | - Hanlei Zhang
- Department of Gastroenterology, the Affiliated Provincial Hospital, Anhui Medical University, Hefei, China
| | - Fang Fang
- Department of Gastroenterology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chao Ye
- Department of Gastroenterology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Kaiguang Zhang
- Department of Gastroenterology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China,Correspondence: Si Chen Kaiguang Zhang
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Autoimmune pancreatitis: can we truly recognize it? Usefulness of contrast-enhanced ultrasonography in two different cases. Eur J Gastroenterol Hepatol 2022; 34:885-886. [PMID: 35802532 DOI: 10.1097/meg.0000000000002397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Miratashi Yazdi SA, Nazar E, Vesali B. IgG4-related cholecystitis misinterpreted as gallbladder cancer, a case report. Ann Med Surg (Lond) 2022; 77:103615. [PMID: 35638058 PMCID: PMC9142613 DOI: 10.1016/j.amsu.2022.103615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Immunoglobulin G4-related disease (IgG4-RD) is a new defined entity with features that factually have been overlapped with other diseases with distinctly diverse treatments and prognoses. Case presentation This report describes a 50-year-old woman who presented with abdominal pain from 3 months ago. The patient underwent open cholecystectomy with Roux-en-Y hepaticojejunostomy due to suspicious of malignancy. The histological examinations revealed acute on chronic cholecystitis with extensive fibrosis and many inflammatory cells infiltration composed of plasmacells and eosinophils without any evidence of malignancy. Pathological and immunohistochemical examination for IgG4 compatible with IgG4-RD. So, pathological assessment is essential for the diagnosis. Conclusion IgG4-RD in gastrointestinal tract frequently misinterpret as malignancy before surgery, and surgeon should notice this disease in the differential diagnosis in order to choose the treatment. IgG4-related disease is rare fibroinflammatory condition. Gastrointestinal IgG4-related disease is problematic to establish previous surgery. Malignancy is main differential diagnosis of IgG4-related cholecystitis.
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Affiliation(s)
| | - Elham Nazar
- Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author. Department of pathology, Tehran University of Medical sciences, Tehran, Iran
| | - Behnoud Vesali
- Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
IgG4-related conditions affecting the digestive tract are part of a multi-organ fibro-inflammatory disorder termed IgG4-related disease (IgG4-RD), with autoimmune pancreatitis and IgG4-related cholangitis being the most prominent manifestations. Gastrointestinal symptoms include jaundice, weight loss, abdominal pain, biliary strictures, and pancreatic and hepatic masses that mimic malignant diseases. IgG4-RD manifestations occur less frequently elsewhere in the digestive tract, namely in the oesophagus, retroperitoneum or intestine. Evidence-based European guidelines frame the current state-of-the-art in the diagnosis and management of IgG4-related digestive tract disease. Diagnosis is based on histology (if available), imaging, serology, other organ involvement and response to therapy (HISORt criteria). Few biomarkers beyond serum IgG4 concentrations are reliable. The first-line therapy (glucocorticoids) is swiftly effective but disease flares are common at low doses or after tapering. Second-line therapy might consist of other immunosuppressive drugs such as thiopurines or rituximab. Further trials, for example, of anti-CD19 drugs, are ongoing. Although an association between IgG4-RD and the development of malignancies has been postulated, the true nature of this relationship remains uncertain at this time.
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8
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Persistent enlargement of the pancreatic gland after glucocorticoid therapy increases the risk of relapse in IgG4-related autoimmune pancreatitis. Clin Rheumatol 2022; 41:1709-1718. [PMID: 35175447 DOI: 10.1007/s10067-022-06091-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aims to clarify the relationship between the changes of pancreatic size after glucocorticoid (GC) therapy and relapse in IgG4-related autoimmune pancreatitis (AIP). METHODS We prospectively enrolled 205 newly diagnosed IgG4-related AIP patients. 145 patients were followed up for more than 3 years. These patients were divided into three groups according to the changes of pancreatic size after treatment of 6 months: pancreatic swelling, normal size, and pancreatic atrophy. Baseline clinical and laboratory parameters were compared among three groups. Kaplan-Meier survival analysis was performed in the 134 patients based on GC therapy. Besides, Cox regression analysis and logistic regression analysis were performed to identify risk factors associated with relapse and the potential variables affecting changes of pancreatic size after treatment. RESULTS Age at diagnosis, white blood cell count, and serum IgG1 level at baseline were significantly different among the three groups. After treatment of 6 months, the pancreas of most patients (n = 81, 55.9%) could return to normal size, while persistent pancreatic swelling was found in 24.1% patients (n = 35), and atrophy was observed in 20.0% of the patients (n = 29). Kaplan-Meier survival analysis presented patients with pancreatic swelling after 6 months of GC therapy were more likely to relapse in the follow-up of 3 years. Persistent pancreatic swelling after treatment and salivary gland involvement at baseline were independent risk variables associated with relapse in IgG4-related AIP patients, while GC-based therapy was a protective factor of relapse. Logistic regression analysis revealed that older age at diagnosis was associated with pancreatic atrophy and higher baseline serum IgG1 level was associated with pancreatic swelling after treatment of 6 months. CONCLUSIONS Patients with persistent pancreatic swelling after GC-based therapy of 6 months were more likely to relapse in the follow-up of 3 years. Older age at diagnosis and higher baseline serum IgG1 level were potential variables associated with pancreatic atrophy or swelling after treatment of 6 months. Key Points • Patients with persistent pancreatic swelling after glucocorticoid-based therapy were more likely to relapse in IgG4-related autoimmune pancreatitis. • Older age at diagnosis was associated with pancreatic atrophy after glucocorticoid-based therapy. • Higher baseline serum IgG1 level was associated pancreatic swelling after glucocorticoid-based therapy.
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9
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Geiselmann MT, Acampa DJ, Melamed J, Arif F, Takabe K, Seitelman E, Datta R, Gunasekaran G, Takahashi H. Immunoglobulin G4-Negative Inflammatory Pseudotumors of the Pancreas. World J Oncol 2022; 12:240-245. [PMID: 35059084 PMCID: PMC8734500 DOI: 10.14740/wjon1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 11/11/2022] Open
Abstract
Inflammatory pseudotumor (IPT) can occur in any organ, but rarely shows pancreatic involvement. While surgical excision has been recommended as the primary treatment for IPT of the pancreas in the past, some authors suggest observation while medical management often results in regression. Corticosteroids, nonsteroidal anti-inflammatory drugs and immunosuppressive therapy have been used to treat IPTs. Spontaneous regression has also been reported in IPT managed without surgical intervention. A 62-year-old female was evaluated for worsening abdominal pain and a mass in the neck of the pancreas that was identified on ultrasound. Further imaging with magnetic resonance imaging revealed a pancreatic mass with dilated pancreatic duct and an atrophic parenchyma of the pancreatic neck. Her serum tumor markers were not elevated. As this lesion appeared to be resectable pancreatic cancer based on cross-sectional imaging, no biopsy was performed prior to surgical resection. Distal pancreatectomy and splenectomy was recommended and the patient desired to proceed. Her recovery was uneventful with no postoperative complications, including pancreatic fistula. Final pathology revealed a lesion consistent with the diagnosis of immunoglobulin G4 (IgG4)-negative IPT without neoplasm. IPT of the pancreas is a difficult entity to diagnose and treat due to clinical and imaging characteristics closely resembling pancreatic adenocarcinoma. Biopsy with immunohistochemical analysis can be useful in diagnosing IPT; however, symptomatic lesions and concerning findings on cross-sectional imaging may warrant more definitive surgical intervention.
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Affiliation(s)
- Matthew T Geiselmann
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Daniel J Acampa
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Joshua Melamed
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Farzana Arif
- Department of Pathology, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA.,Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Eric Seitelman
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Rajiv Datta
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Ganesh Gunasekaran
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA.,Department of Surgery, Division of HPB Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Hideo Takahashi
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
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Lu S, Liang J, Liao S, Wu D, Wu F, Li H. Use of MRI signal intensity ratio to differentiate between autoimmune pancreatitis and pancreatic ductal adenocarcinoma. Clin Radiol 2021; 77:e84-e91. [PMID: 34756699 DOI: 10.1016/j.crad.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/01/2021] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the accuracy of the lesion-to-erector spinae signal intensity ratio (SIR) on magnetic resonance imaging (MRI) for distinguishing autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDA). MATERIALS AND METHODS The MRI data of 21 patients with AIP and 27 patients with PDA were analysed retrospectively, and the signal intensity in pancreatic lesions and erector spinae muscles at the same level on T2-weighted imaging (T2WI), arterial phase (AP) imaging, and delayed phase (DP) imaging was measured for calculation of SIRs. RESULTS The mean SIRs of the pancreatic lesions and erector spinae from T2WI, AP, and DP images of AIP patients were 0.96, 1.27, and 1.42, respectively, while those of PDA patients were 1.35, 0.80, and 0.91, respectively. The differences in the SIRs between the AIP and PDA groups were statistically significant (p<0.001), with corresponding area under curve (AUC) values of 0.925, 0.906, and 0.961, respectively. The optimal cut-off values for the SIRs on T2WI, AP and DP images were 1.21, 1.01, and 1.08, respectively. SIR values < 1.21 on T2WI, >1.01 on AP imaging, and >1.08 on DP imaging identified AIP with sensitivities of 85.7%, 90.5%, and 90.5%, respectively, and specificities of 81.5%, 74.6%, and 81.5%, respectively. The AUC values for SIRs did not differ significantly between T2WI and DP imaging or AP and DP imaging (Z = 0.778, p=0.436; Z = 1.279, p=0.201). CONCLUSION The SIRs of pancreatic lesions and erector spinae on T2WI, AP, and DP images can be used to differentiate AIP from PDA.
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Affiliation(s)
- S Lu
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; Department of Radiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - J Liang
- Department of Radiology, Shenzhen Baoan Hospital, Southern Medical University, Shenzhen, 518101, China
| | - S Liao
- Department of Radiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - D Wu
- Department of Radiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - F Wu
- Department of Radiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - H Li
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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Sugino K, Ono H, Hebisawa A, Tsuboi E. Eosinophilic bronchiolitis successfully treated with benralizumab. BMJ Case Rep 2021; 14:14/10/e246058. [PMID: 34667050 PMCID: PMC8527136 DOI: 10.1136/bcr-2021-246058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 53-year-old non-smoking Japanese woman was admitted to our hospital with a 20-year history of wet cough and dyspnoea on exertion. Bronchial asthma (BA) had been diagnosed 20 years earlier. Although she has been treated with high-dose inhaled corticosteroid, she had experienced frequent exacerbation of BA, and short-term oral corticosteroid bursts were occasionally administered. High-resolution CT of the chest revealed diffuse centrilobular nodules with bronchial wall thickening and patchy ground-glass opacities in both lungs. Lung biopsy specimens showed widespread cellular bronchiolitis with follicle formations in the membranous and respiratory bronchioles, accompanied by marked infiltration of plasma cells and eosinophils. In addition, immunohistochemical immunoglobulin G4 (IgG4) staining revealed many IgG4-positive plasma cells, and the ratio of IgG4-positive cells to IgG-positive cells exceeded 40%. The final diagnosis was eosinophilic bronchiolitis with marked IgG4-positive plasma cell infiltration in association with BA. With benralizumab therapy, her clinical condition dramatically improved.
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Affiliation(s)
- Keishi Sugino
- Department of Respiratory Medicine, Tsuboi Hospital, Koriyama, Japan
| | - Hirotaka Ono
- Department of Respiratory Medicine, Tsuboi Hospital, Koriyama, Japan
| | - Akira Hebisawa
- Department of Histopathology, Kokuho Asahi Chuo Hospital, Asahi, Japan
| | - Eiyasu Tsuboi
- Department of Respiratory Medicine, Tsuboi Hospital, Koriyama, Japan
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Rodrigues T, Boike JR. Biliary Strictures: Etiologies and Medical Management. Semin Intervent Radiol 2021; 38:255-262. [PMID: 34393335 DOI: 10.1055/s-0041-1731086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Biliary strictures have several etiologies that can broadly be classified into benign and malignant causes. The clinical presentation is variable with strictures identified incidentally on imaging or during the evaluation of routine laboratory abnormalities. Symptoms and cholangitis lead to imaging that can diagnose biliary strictures. The diagnosis and medical management of biliary strictures will be discussed in this article.
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Affiliation(s)
- Terrance Rodrigues
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Justin R Boike
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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13
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Suda T, Kobayashi M, Kurokawa K, Matsushita E. Simultaneous occurrence of autoimmune pancreatitis and sclerosing cholangitis as immune-related adverse events of pembrolizumab. BMJ Case Rep 2021; 14:14/6/e243360. [PMID: 34088696 DOI: 10.1136/bcr-2021-243360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A 57-year-old man with lung cancer, previously treated with the programmed death-1 inhibitor pembrolizumab, was evaluated for liver injury and acute pancreatitis. Serum IgG4 levels were not elevated. Contrast-enhanced CT showed pancreatic swelling, contrast unevenness in the liver and thickening of the common bile duct and gall bladder. Magnetic resonance cholangial pancreatography revealed beads in the left intrahepatic bile duct and localised narrowing of the head and body of the central pancreatic duct. Endoscopic ultrasound-guided fine-needle and liver needle biopsy showed CD8+ and CD4+ T lymphocyte aggregates, whereas immunostaining revealed greater infiltration by CD8+ cells than CD4+ cells. IgG4-related disease was ruled out based on serum and pathological findings. The patient simultaneously presented with immune-related adverse events, autoimmune pancreatitis-like features and sclerosing cholangitis, which were ameliorated by steroid therapy. CD8+ lymphocytes were the dominant infiltrating cells in autoimmune pancreatitis and sclerosing cholangitis.
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Affiliation(s)
- Tsuyoshi Suda
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
| | - Masako Kobayashi
- Department of Pathology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
| | - Koji Kurokawa
- Department of Respiratory Medicine, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
| | - Eiki Matsushita
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
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Biliary inflammation scoring for immunoglobulin G4-related sclerosing cholangitis: an endoscopic approach with endoscopic ultrasound. Surg Endosc 2021; 35:7068-7073. [PMID: 33492512 DOI: 10.1007/s00464-020-08222-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS The differential diagnosis of immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) and cholangiocarcinoma (CC) remains a clinical challenge. Imaging modalities play critical roles in the diagnosis of IgG4-SC. The present study aimed to evaluate the differential diagnosis of IgG4-SC and CC based on images of endoscopic ultrasound (EUS). METHODS The biliary inflammation scoring (BIS) method for EUS was developed based on the comparison between images of IgG4-SC and that of cholangiocarcinoma (CC) and other acute or chronic cholangitis. In the BIS diagnostic phase, the EUS images from 66 IgG4-SC patients and 44 CC patients were blindly evaluated using the BIS methods. RESULTS The sensitivity, specificity, and accuracy of the newly established BIS in distinguishing IgG4-SC from CC were 86% [95% confidence interval (CI) 75-93%], 95% (95% CI 83-99%), and 90% (95% CI 83-94%), respectively. CONCLUSION EUS should be considered to be added to the workup algorithm in patients with suspected IgG4-SC as a useful diagnostic procedure. BIS is a promising diagnostic method to discriminate IgG4-SC during the ongoing endoscopy.
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Jia YC, Ding YX, Mei WT, Wang YT, Zheng Z, Qu YX, Liang K, Li J, Cao F, Li F. Extracellular vesicles and pancreatitis: mechanisms, status and perspectives. Int J Biol Sci 2021; 17:549-561. [PMID: 33613112 PMCID: PMC7893579 DOI: 10.7150/ijbs.54858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Comprehensive reviews and large population-based cohort studies have played an important role in the diagnosis and treatment of pancreatitis and its sequelae. The incidence and mortality of pancreatitis have been reduced significantly due to substantial advancements in the pathophysiological mechanisms and clinically effective treatments. The study of extracellular vesicles (EVs) has the potential to identify cell-to-cell communication in diseases such as pancreatitis. Exosomes are a subset of EVs with an average diameter of 50~150 nm. Their diverse and unique constituents include nucleic acids, proteins, and lipids, which can be transferred to trigger phenotypic changes of recipient cells. In recent years, many reports have indicated the role of EVs in pancreatitis, including acute pancreatitis, chronic pancreatitis and autoimmune pancreatitis, suggesting their potential influence on the development and progression of pancreatitis. Plasma exosomes of acute pancreatitis can effectively reach the alveolar cavity and activate alveolar macrophages to cause acute lung injury. Furthermore, upregulated exosomal miRNAs can be used as biomarkers for acute pancreatitis. Here, we summarized the current understanding of EVs in pancreatitis with an emphasis on their biological roles and their potential use as diagnostic biomarkers and therapeutic agents for this disease.
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Affiliation(s)
- Yu-Chen Jia
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yi-Xuan Ding
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Wen-Tong Mei
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | | | - Zhi Zheng
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yuan-Xu Qu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Kuo Liang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Jia Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
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Ma X, Xu H, Sun JY, Gedara YSS, Sun F. Idiopathic membranous nephropathy in a patient diagnosed with IgG4-related disease: A case report. Medicine (Baltimore) 2020; 99:e22817. [PMID: 33080759 PMCID: PMC7571987 DOI: 10.1097/md.0000000000022817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 09/12/2020] [Accepted: 09/21/2020] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Immunoglobulin (Ig) G4-related disease (IgG4-RD) is a newly recognized, systemic disease. Membranous nephropathy is the most common glomerular lesion in IgG4- related kidney disease. However, the lack of relationship with IgG4-related kidney disease and monoclonal gammopathy of undetermined significance (MGUS) warrants investigation of the potential mechanisms. PATIENT CONCERNS A 62-year-old patient was diagnosed with IgG4-RD, tubulointerstitial nephritis, retroperitoneal fibrosis. After 2 years, she was presented with proteinuria, hypoproteinemia, facial, and bilateral lower limb edema. Furthermore, this patient exhibited deposits of IgG k of monoclonal hyperplasia, and bone marrow plasma cell count was 2.5%. DIAGNOSIS The patient was diagnosed with nephrotic syndrome, acute kidney injury, and MGUS. The pathological diagnosis was IgG4-related tubulointerstitial nephritis, IgG4-related membranous nephropathy. INTERVENTIONS The patient was treated with intravenous methylprednisolone (40 mg daily), which was changed to oral prednisone 50 mg/d after 2 months. OUTCOMES After 1 month, the patient exhibited a rapid response only with corticosteroid, and experienced partial remission of serum albumin and proteinuria. LESSONS This case may suggest a possible relationship between IgG4-RD and MGUS, provide some guidance for investigating the mechanism between them.
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Cho MJ, Moon HS, Lee HS, Park JH, Kim JS, Kang SH, Lee ES, Kim SH, Sung JK, Lee BS, Jeong HY. Immunoglobulin G4-related disease in the stomach presenting as a gastric subepithelial tumor: Case report. Medicine (Baltimore) 2020; 99:e22078. [PMID: 32899079 PMCID: PMC7478664 DOI: 10.1097/md.0000000000022078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder characterized by specific pathologic findings and often, but not in all cases, elevated serum IgG4 concentration. Although it can virtually involve every organ system, cases involving the gastrointestinal tract and especially gastric mass lesions have rarely been reported. PATIENT CONCERNS A 45-year-old man, who was incidentally discovered asymptomatic subepithelial tumor (SET), by endoscopy, on the greater curvature of the upper gastric body, was referred to our hospital for further evaluation. DIAGNOSIS The patient was postoperatively diagnosed with IgG4-RD by histopathologic results. INTERVENTIONS The patient underwent laparoscopic wedge resection. OUTCOMES The patient is presently followed up annually in our clinic and had no problems and showed no signs of recurrence in examination. CONCLUSION We reported a rare case of IgG4-RD presenting as a gastric SET. The first line treatment of IgG4-RD is glucocorticoid administration. However, because pathologic examination is challenging owing to the lesion location, preoperative diagnosis is difficult and may lead to unnecessary gastric resection. Thus, using alternative preoperative diagnostic methods such as endoscopic ultrasound-guided fine-needle biopsy or the biopsy unroofing technique could spare the patient from unnecessary surgical treatment.
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Iyengar NS, Golub D, McQuinn MW, Hill T, Tang K, Gardner SL, Harter DH, Sen C, Staffenberg DA, Thomas K, Elkin Z, Belinsky I, William C. Orbital Rosai-Dorfman disease initially diagnosed as IgG4-related disease: a case report. Acta Neuropathol Commun 2020; 8:113. [PMID: 32682450 PMCID: PMC7368749 DOI: 10.1186/s40478-020-00995-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/09/2020] [Indexed: 01/13/2023] Open
Abstract
Inflammatory orbital lesions include a broad list of diagnoses, many of them with overlapping clinical and radiographic features. They often present a diagnostic conundrum, even to the most experienced orbital specialist, thus placing considerable weight on surgical biopsy and histopathological analysis. However, histopathological diagnosis is also inherently challenging due to the rarity of these lesions and the overlaps in histologic appearance among distinct disease entities. We herein present the case of an adolescent male with a subacutely progressive orbital mass that generated a significant diagnostic dilemma. Early orbital biopsy was consistent with a benign fibro-inflammatory lesion, but corticosteroid therapy was ineffective in halting disease progression. After an initial substantial surgical debulking, histopathological analysis revealed several key features consistent with IgG4-related disease (IgG4-RD), a systemic fibro-inflammatory process typically accompanied by multifocal tumor-like lesions. Surprisingly, within months, there was clear evidence of clinical and radiographic disease progression despite second-line rituximab treatment, prompting a second surgical debulking. This final specimen displayed distinctive features of Rosai-Dorfman disease (RDD), a systemic inflammatory disease characterized by uncontrolled histiocytic proliferation. Interestingly, certain features of this re-excision specimen were still reminiscent of IgG4-RD, which not only reflects the difficulty in differentiating RDD from IgG4-RD in select cases, but also illustrates that these diagnoses may exist along a spectrum that likely reflects a common underlying pathogenetic mechanism. This case emphasizes the importance of surgical biopsy or resection and histopathological analysis in diagnosing—and, ultimately, treating—rare, systemic inflammatory diseases involving the orbit, and, furthermore, highlights the shared histopathological features between RDD and IgG4-RD.
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Dias AB, Horvat N, Begnami MD, Abe ES, Viana PCC, Machado MCC. Case report of IgG4-related appendiceal disease: A challenging disease. Medicine (Baltimore) 2020; 99:e20588. [PMID: 32569185 PMCID: PMC7310901 DOI: 10.1097/md.0000000000020588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Immunoglobulin G4 (IgG4)-related disease is an increasingly recognized immune-mediated entity that can affect virtually every organ system. Depending on the location of the disease, it can present a wide range of clinical manifestations and even mimic malignancies. Appendiceal involvement in patients with IgG4-related disease is particularly rare and very few cases are reported in the literature. PATIENT CONCERNS We report a case of IgG4-related appendiceal disease in a 42-year-old woman who presents with a subacute onset of right lower quadrant abdominal pain. DIAGNOSIS Abdominal computed tomography showed a markedly enlarged appendix, raising the concern of malignancy. The diagnosis of IgG4 appendiceal disease was confirmed by postoperative histopathologic and immunohistochemical examination. INTERVENTIONS The patient underwent right hemicolectomy. OUTCOMES After the surgery, the patient had an uneventful recovery and reported a resolution of her symptoms. The serum IgG4 was revaluated 5 days after surgery and returned to its normal values. At the 3-year follow up, the patient had no recurrence of symptoms and her imaging exams remain unremarkable. LESSONS This study reports the fifth case of IgG4-related appendiceal disease. Increasing awareness of this condition may influence the management of these patients, once patients with IgG4-related disease should be monitored after treatment, due to the risk of recurrence or involvement of other organs.
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Mahalingam S, Langdon J, Muniraj T, Do A, Guo Y, Spektor M, Mathur M. Endoscopic Retrograde Cholangiopancreatography: Deciphering the Black and White. Curr Probl Diagn Radiol 2020; 50:74-84. [PMID: 32063296 DOI: 10.1067/j.cpradiol.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/01/2020] [Accepted: 01/06/2020] [Indexed: 12/12/2022]
Abstract
Endoscopic Retrograde Cholangiopancreatography (ERCP) remains the conventional method of imaging the pancreatic and biliary tree and is performed by direct injection of iodinated contrast material via the major papilla. This diagnostic procedure gained popularity in the 1970s and subsequently paved way for ERCP guided interventions such as sphincterotomy, stone retrieval and stent placement. Currently, therapeutic ERCP is more widespread than diagnostic ERCP primarily due to the availability of noninvasive imaging. Nevertheless, more than half a million ERCPs are performed annually in the United States and radiologists need to be comfortable interpreting them. The following review will familiarize the reader with the imaging appearances of biliary and pancreatic disorders on conventional ERCP, and elaborate on therapeutic ERCP with illustrative examples.
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Affiliation(s)
- Sowmya Mahalingam
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT.
| | - Jonathan Langdon
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | | | - Albert Do
- Yale University School of Medicine, Section of Digestive Diseases, New Haven, CT
| | - Yang Guo
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT; Brigham and Women's Hospital, Brookline, MA
| | - Michael Spektor
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Mahan Mathur
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
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Kwag MH, Park JY, Jeong HW, Han JY, Lim JH, Kim YS, Park JW. Overlooked and Challenging Encounters–Inflammatory Pseudotumors in the Abdomen and Pelvis: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1121-1133. [PMID: 36238032 PMCID: PMC9431880 DOI: 10.3348/jksr.2019.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 11/15/2022]
Abstract
Inflammatory pseudotumors (IPTs) are uncommon, mass-forming lesions, predominantly involving the lung and orbit. Although the incidence of IPTs is rare in the abdomen and pelvis, they can be encountered as enhancing, soft-tissue lesions, mimicking malignancy or fibrosclerosing disease. Generally, they exhibit a wide range of nonspecific imaging features in various organs. Preoperative imaging diagnosis of IPTs in appropriate clinical settings may help determine proper patient management. In this article, we review radiologic findings of IPTs in the abdominopelvic cavity, including the liver, spleen, kidney, gastrointestinal tract, mesentery, pelvis, and retroperitoneum.
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Affiliation(s)
- Min Ha Kwag
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jin Young Park
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ji Yeon Han
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jong Heon Lim
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Seon Kim
- Department of Radiology, Yeungnam University Hospital, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jung Won Park
- Department of Radiology, Gimhaebokum Hospital, Gimhae, Korea
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Ufuk F, Duran M. IgG4 related autoimmune pancreatitis and sclerosing cholangitis. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:303-304. [PMID: 30457561 DOI: 10.5152/tjg.2018.17767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Furkan Ufuk
- Department of Diagnostic Radiology, University of Pamukkale, Denizli, Turkey
| | - Mehmet Duran
- Department of Diagnostic Radiology, University of Pamukkale, Denizli, Turkey
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Wang X, Wan J, Zhao L, Da J, Cao B, Zhai Z. IgG4-related disease with tracheobronchial miliary nodules and asthma: a case report and review of the literature. BMC Pulm Med 2019; 19:191. [PMID: 31666048 PMCID: PMC6822466 DOI: 10.1186/s12890-019-0957-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background IgG4-related disease (IgG4-RD) is a systemic autoimmune disease that can affect multiple organs of the body. Pulmonary manifestations of IgG4-RD include pulmonary solid nodules, thickening of bronchovascular bundles, interstitial involvement, and ground glass opacities. Here we present a rare case of IgG4-RD with tracheobronchial nodules and review the relevant literature. Case presentation A 52-year-old man was admitted to our hospital with a history of intermittent cough for 27 months and recurrent wheezing for 17 months. He had been diagnosed with asthma prior to admission and was responsive to oral prednisone (30 mg/day, with gradual tapering). Bronchoscopy performed 2 years prior to admission showed tracheal and bronchial mucosal hyperemia, edema, and miliary nodules. Pathological tests showed chronic inflammation with focal lymphocytic infiltration in the bronchial mucosa. The patient had recurrent cough and wheezing after prednisone was stopped or the dose reduced. At the time of admission to our hospital, his serum immunoglobulin G4 (IgG4) level had increased to 7.35 g/L. Following bronchoscopy, the IgG4 expression in the bronchial mucosa was compared with that observed during the last two bronchoscopies. Bronchoscopy performed 7 months prior to admission revealed IgG4+ plasma cell infiltration in the bronchial tissue, with > 10 IgG4+ plasma cells per high power field and an IgG4+/IgG+ cell ratio of > 40%. The current bronchoscopy revealed a decrease in IgG4 expression in the bronchial tissue, probably because of the intermittent prednisone treatment. The case fulfilled the comprehensive clinical diagnostic criteria for IgG4-RD. He received prednisone and azathioprine, and he has never developed recurrence. Conclusions Our case exhibited three important clinical indication: First, tracheobronchial miliary nodules could be the presentation of IgG4-related disease. Second, IgG4-related disease with pulmonary involvement has close connection with asthma. Last, IgG4-related disease can be very sensitive to prednisone, the infiltration of IgG4 positive plasma cells decreased after prednisone treatment and symptoms significantly improved in our case. In conclusion, we reported the first case of IgG4-RD presenting with miliary nodules on the tracheal and bronchial tube walls combined with asthma. The findings will further our understanding of the characteristics of IgG4-RD.
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Affiliation(s)
- Xiuling Wang
- Center for Respiratory Diseases, China-Japan Friendship Hospital; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Peking University Health Science Center, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, People's Republic of China.,Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167, Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Jun Wan
- Center for Respiratory Diseases, China-Japan Friendship Hospital; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Peking University Health Science Center, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, People's Republic of China.
| | - Ling Zhao
- Department of Pathology, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Jiping Da
- Department of Pathology, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Bin Cao
- Center for Respiratory Diseases, China-Japan Friendship Hospital; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Peking University Health Science Center, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Zhenguo Zhai
- Center for Respiratory Diseases, China-Japan Friendship Hospital; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Peking University Health Science Center, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, People's Republic of China
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Patil RP, Patil PD, Thakar AB. Panchakarma in autoimmune pancreatitis: A single-case study. Ayu 2019; 40:242-246. [PMID: 33935442 PMCID: PMC8078606 DOI: 10.4103/ayu.ayu_15_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/05/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
Autoimmune pancreatitis (AIP) is the pancreatic manifestation of a systemic fibro-inflammatory disorder. AIP is a unique form of pancreatitis in which autoimmune mechanisms are suspected to be involved in the pathogenesis. AIP is a rare disorder, its exact cause is unknown, but it is thought to be caused by the body’s immune system attacking the pancreas and it responds to steroid therapy only. In Ayurveda, although there is no synonym for AIP, but has a resemblance in clinical features of Grahani Dosha (derangement of duodenum and intestine). The cause of Grahani Dosha is Mandagni (hypofunctioning of Agni) and Panchakarma therapy increases Agni. As per Charaka Samhita, treatment for Grahani Dosha amongst the Panchakarma therapy is Virechana (therapeutic purgation) and Basti (medicated enema). The present case report is of a 30-year-old female, diagnosed as case of AIP with multisystem involvement with increased level of immunoglobulin G (IgG), glycosylated heamoglobin (HbA1c), cholesterol, triglycerides, low-density lipoprotein (LDL) and body mass index (BMI). The patient was on anticholinergic agents, antacids, levothyroxine, multivitamin along with iron and antihistamine drugs since 1 year, but with not much relief. Patient was treated with classical Virechana and MadhutailikaBasti. It was observed after the completion of therapy, that there was decrease in IgG, HbA1c, S. cholesterol, S. triglyceride, low density lipoprotein (LDL) and body mass index (BMI). This shows that Virechana and Basti play a significant role in patient with AIP associated with other disorders.
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Affiliation(s)
- Rajkala P Patil
- Department of Panchakarma, Central Ayurveda Research Institute for Cardiovascular Diseases, Punjabi Bagh, India
| | - Panchakshari D Patil
- Publication Section, Central Council for Research in Ayurvedic Sciences, Janakpuri, New Delhi, India
| | - Anup B Thakar
- Department of Panchakarma, Institute of Teaching and Research in Ayurveda, Jamnagar, Gujarat, India
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Kuruma S, Kamisawa T, Kikuyama M, Chiba K, Shimizuguchi R, Koizumi S, Tabata T. Clinical characteristics of autoimmune pancreatitis with IgG4 related kidney disease. Adv Med Sci 2019; 64:246-251. [PMID: 30826634 DOI: 10.1016/j.advms.2018.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/29/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To clarify the clinical characteristics of autoimmune pancreatitis (AIP) in immunoglobulin (Ig)G4-related kidney disease (IgG4-RKD). PATIENTS AND METHODS A total of 92 patients with AIP were divided into an IgG4-RKD-positive group (RKD-P group, n = 13) and an IgG4-RKD-negative group (RKD-N group, n = 79) on the basis of the diagnostic criteria for IgG4-RKD. Clinical characteristics, including: age; sex; the presence of extrapancreatic lesions other than renal lesions, proteinuria, and hematuria; serum concentrations of IgG, IgG4, IgE, and creatinine; and urinary concentrations of liver-type fatty acid binding protein, α1-microglobulin, β2-microglobulin, and N-acetyl-β-d-glucosaminidase were compared between the RKD-P and RKD-N groups. The clinical course of the RKD-P group was also characterized. RESULTS The prevalence of extrapancreatic lesions other than renal lesions was significantly higher in the RKD-P group (84.6% vs 43.0%,p < 0.01). Serum creatinine (1.19 mg/dl versus 0.74 mg/dl, p < 0.05), urinary β2-microglobulin (6609.8 μg/l vs 265.8 μg/l, p < 0.05), and the prevalence of proteinuria (30.7% vs 7.6%, p < 0.05) were significantly higher in the RKD-P group. Nine out of thirteen patients in the RKD-P group had multiple low-density renal lesions on enhanced computed tomography, 3 patients had multiple high-intensity lesions on diffusion-weighted magnetic resonance images, and 1 patient had diffuse thickening of the renal wall, with a smooth intra-luminal surface. CONCLUSIONS Patients who had AIP with IgG4-RKD were more likely to have extrapancreatic lesions other than those in the kidney, and their serum creatinine and urinary β2-microglobulin concentrations were significantly higher than in those without IgG4-RKD.
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Vashi B, Khosroshahi A. IgG4-Related Disease with Emphasis on Its Gastrointestinal Manifestation. Gastroenterol Clin North Am 2019; 48:291-305. [PMID: 31046976 DOI: 10.1016/j.gtc.2019.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IgG4-related disease is an immune-mediated fibroinflammatory condition with a diverse spectrum of organ involvement, commonly in the pancreas and bile ducts among other organs such as salivary and lacrimal glands. Classic histopathologic findings are the gold standard for confirmation of diagnosis, although diagnosis remains challenging, as biomarkers to date are neither sufficient nor necessary. Glucocorticoids are the most effective initial treatment, generally having a dramatic response, although limited clinical evidence exists regarding effective maintenance therapy. This review summarizes key GI manifestations of this condition for the practicing gastroenterologist and addresses the pathology, disease mechanism, and current therapeutic recommendations.
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Affiliation(s)
- Bijal Vashi
- Department of Medicine, Emory University, 200 Whitehead Building, 615 Michael Street, Atlanta, GA 30322, USA
| | - Arezou Khosroshahi
- Department of Medicine, Emory University, 244 Whitehead Building, 615 Michael Street, Atlanta, GA 30322, USA.
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Gonzalez HH, Skrove JL, Rosen S, Sobrado J. A Curious Case of Autoimmune Pancreatitis with IgG4-related Sclerosing Cholangitis. Cureus 2019; 11:e4153. [PMID: 31058036 PMCID: PMC6488342 DOI: 10.7759/cureus.4153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is a novel entity that belongs to the immune-mediated fibroinflammatory class of IgG4-related diseases (IgG4-RD). IgG4-SC is noted to be one of the most frequent manifestations of extra-pancreatic disease among IgG4-RD, which is significantly different from primary SC (PSC) and cholangiocarcinoma (CC) as is evident in the varied approaches to treatment. IgG4-RD includes IgG4-SC and autoimmune pancreatitis (AIP). Herein, we presented a case of IgG4-SC in a patient with obstructive jaundice secondary to AIP. We have also discussed the current recommendations for diagnostic and treatment modalities, with an emphasis on the issues that arise in obtaining a definitive classification of disease.
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Affiliation(s)
- Hector H Gonzalez
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Jamie L Skrove
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | - Seth Rosen
- Gastroenterology, Larkin Community Hospital, South Miami, USA
| | - Javier Sobrado
- Internal Medicine, Larkin Community Hospital, South Miami, USA
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AbdelRazek MA, Venna N, Stone JH. IgG4-related disease of the central and peripheral nervous systems. Lancet Neurol 2019; 17:183-192. [PMID: 29413316 DOI: 10.1016/s1474-4422(17)30471-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/20/2017] [Accepted: 12/12/2017] [Indexed: 02/08/2023]
Abstract
IgG4-related disease can involve nearly any organ system, including the central and peripheral nervous systems. The pathology findings are consistent from organ to organ, but careful clinicopathological correlation is necessary to establish the diagnosis. Many non-neurological and neurological inflammatory conditions, previously regarded as idiopathic in nature, are now recognised to fall within the spectrum of IgG4-related disease. The condition is highly treatable, but probably remains substantially under-recognised. In this Review, we offer an important and timely update on the current and emerging aspects of this neurological disease. Following a short overview of IgG4-related disease, we describe the current understanding of neurological findings, pathophysiology, approaches to diagnosis, and treatment of IgG4-related disease affecting the central and peripheral nervous systems.
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Affiliation(s)
| | - Nagagopal Venna
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - John H Stone
- Rheumatology Clinic, Massachusetts General Hospital, Boston, MA, USA.
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A rare presentation of IgG4 related disease as a gastric antral lesion: Case report and review of the literature. Int J Surg Case Rep 2018; 51:244-247. [PMID: 30218821 PMCID: PMC6138857 DOI: 10.1016/j.ijscr.2018.08.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023] Open
Abstract
IgG4RD is a newly recognized systemic disease affecting nearly every organ. IgG4RD presenting as a gastric mass is extremely rare. Preoperative biopsy is mandatory for definitive diagnosis. When diagnosed before surgery, the treatment is medical with IV steroids.
Introduction Immunoglobulin G4 related disease is a recently recognized systemic fibro-inflammatory disorder affecting virtually every organ in the body, characterized by lympho-plasmacytic dense infiltrates rich in IgG4 positive plasmacytes along with storiform fibrosis, inconstantly associated with elevated serum IgG4 levels. Few cases of Immunoglobulin G4 related disease occurring solely in the stomach have been published. Presentation of case We herein present a rare case of a 57 year old male patient presenting with an incidentally discovered asymptomatic pre-pyloric submucosal gastric lesion confused with a gastro-intestinal stromal tumor with failed endoscopic biopsy attempts due to tumor mobility. The patient underwent wedge resection of the lesion which was diagnosed postoperatively as Immunoglobulin G4 related disease. Discussion Immunoglobulin G4 related disease presenting as a solitary lesion in the stomach is a very rare condition. It should be kept in the differential diagnosis of a submucosal mass or polyp. The treatment is medical with systemic steroid therapy. Conclusion Obtaining a tissue biopsy is of extreme importance to avoid unnecessary surgery.
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Deng H, Zhao S, Yue Y, Liu Y, Xu Y, Qian J, Ma X, Gao P, Yao X, Jiang X, Xu X, Jing Z, Wang Y, Pan L, Xue X. IgG4-related disease of pulmonary artery causing pulmonary hypertension. Medicine (Baltimore) 2018; 97:e10698. [PMID: 29768335 PMCID: PMC5976312 DOI: 10.1097/md.0000000000010698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IgG4-related disease (IgG4-RD) is recognized as an immune-mediated condition with pathology features of lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis, accompanied with or without elevated serum IgG4 concentrations. However, few of pulmonary artery IgG4-RD causing pulmonary hypertension (PH) was reported.The medical records of 3 patients with pulmonary artery IgG4-RD inducing PH were analyzed retrospectively.Imaging findings demonstrated that the lesions of 3 patients located in pulmonary artery, which were initially diagnosed as pulmonary thrombus or malignant tumor. Computed tomography pulmonary angiography (CTPA), ultrasonic cardiogram, and positron emission tomography/computed tomography (PET/CT) didn't support the diagnosis of pulmonary thrombus or malignant tumor. Right heart catheterization (RHC) showed definite PH. Biopsy by right heart catheterization in 2 patients or pneumonectomy in 1 patient confirmed the diagnosis as IgG4-RD. Treated with glucocorticoids and cyclophosphamide or rituximab, 2 patients' IgG4 concentrations declined sharply and the lesions shrunk gradually. Another patient treated with glucocorticoids died of heart failure.IgG4-RD involved pulmonary artery causing PH was rare. A high index of awareness of this disease is required for early diagnosis and treatment. PET/CT might be a valuable approach to distinguish pulmonary artery IgG4-RD from pulmonary thrombus and malignant tumor.
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Affiliation(s)
- Hui Deng
- Department of Respiratory Disease
| | | | | | - Yong Liu
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University
| | - Yali Xu
- Department of Respiratory Disease
| | - Jin Qian
- Department of Respiratory Disease
| | | | | | | | - Xin Jiang
- Thrombosis and Vascular Medicine Center, Vascular Biology Research Unit in State Key Lab of Cardiovascular Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiqi Xu
- Thrombosis and Vascular Medicine Center, Vascular Biology Research Unit in State Key Lab of Cardiovascular Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zhicheng Jing
- Thrombosis and Vascular Medicine Center, Vascular Biology Research Unit in State Key Lab of Cardiovascular Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | | | - Lei Pan
- Department of Respiratory Disease
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Combined membranous nephropathy and tubulointerstitial nephritis as a rare renal manifestation of IgG4-related disease: a case-based literature review. CEN Case Rep 2018; 7:137-142. [PMID: 29388171 DOI: 10.1007/s13730-018-0311-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/24/2018] [Indexed: 12/24/2022] Open
Abstract
IgG4-related disease (IgG4-RD) is a newly recognized immune-mediated multisystemic disease characterized by a fibro-inflammatory condition with tissue infiltration of IgG4-positive plasma cells and often associated with elevated serum IgG4 levels. Typical renal involvement of IgG4-RD presents as tubulointerstitial nephritis (TIN), membranous or membranoproliferative nephropathy. We are presenting a case with combined IgG4 membranous nephropathy and TIN, as well as a literature review on pathophysiology, diagnosis and treatment of IgG4-RD. A 62-year-old man presented with weight loss and fatigue. Labs showed significant proteinuria and hematuria with elevated serum creatinine (2.5 mg/dL). CT/PET scan found scattered lymphadenopathy without increased FDG uptake. Kidney biopsy showed glomerular lesions as well as severe interstitial fibrosis and tubular atrophy. Immunohistochemistry study was negative for anti-phospholipase A2 receptor antibodies and showed interstitial lymphocytic infiltration with IgG4 positive plasma cells. Patient also had elevated serum IgG4 level and IgG4 to total IgG ratio. Prednisone treatment was initiated soon after the diagnosis was made, patient responded well with proteinuria and hematuria both resolved. IgG4-related disease (IgG4-RD) is a newly increasingly recognized immune-mediated multisystemic disease; IgG4-related membranous nephropathy should be included in the differential diagnosis for patients with proteinuria.
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Hsu WL, Chang SM, Wu PY, Chang CC. Localized autoimmune pancreatitis mimicking pancreatic cancer: Case report and literature review. J Int Med Res 2018; 46:1657-1665. [PMID: 29332510 PMCID: PMC6091832 DOI: 10.1177/0300060517742303] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Autoimmune pancreatitis (AP) is a rare autoimmune pancreatic manifestation of systemic immunoglobulin G4 (IgG4)-related sclerosing disease. Distinguishing between AP and pancreatic cancer is crucial because the clinical courses, treatments, and prognoses of these two disease entities are quite different. We herein report a case involving a 52-year-old man with subacute epigastralgia who visited our hospital for evaluation of a suspicious pancreatic mass found during esophagogastroduodenoscopy. Enhanced computed tomography (CT) revealed an enlarged lesion in the pancreatic head with encasement of hepatic vessels. The lesion also exhibited increased 18F-fluorodeoxyglucose accumulation on positron emission tomography/CT imaging, which was highly suggestive of pancreatic cancer. After open biopsy, morphologic examination showed an inflammatory infiltrate in the pancreas, which was compatible with chronic sclerotic pancreatitis. Further laboratory tests revealed an elevated serum IgG4 level, and the diagnosis of sclerotic pancreatitis was then confirmed. After corticosteroid treatment, the pancreatic lesion showed shrinkage on follow-up CT, and the serum IgG4 titer decreased to the normal range. This case suggests that clinicians should be familiar with the clinical presentations and diagnostic criteria of AP versus pancreatic cancer. An awareness of the differences between these diseases may avoid misdiagnosis and unnecessary surgical intervention.
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Affiliation(s)
- Wen-Ling Hsu
- 1 Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,2 Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Min Chang
- 1 Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Yin Wu
- 3 Concord Clinic, Linya District, Kaohsiung, Taiwan
| | - Chin-Chuan Chang
- 1 Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,4 Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Vu K, Gupta R, Frater J, Atkinson J, Ranganathan P. A 55-Year-Old Man With Periorbital and Inguinal Masses, Pericarditis, and Pleuritis. Arthritis Care Res (Hoboken) 2017; 69:730-736. [PMID: 26815130 DOI: 10.1002/acr.22843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/11/2015] [Accepted: 01/12/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Khoan Vu
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Richa Gupta
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - John Frater
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - John Atkinson
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Prabha Ranganathan
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Outcome and Genetic Factors in IgG4-Associated Autoimmune Pancreatitis and Cholangitis: A Single Center Experience. Gastroenterol Res Pract 2017; 2017:6126707. [PMID: 28348580 PMCID: PMC5352972 DOI: 10.1155/2017/6126707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/19/2017] [Accepted: 01/29/2017] [Indexed: 12/22/2022] Open
Abstract
Introduction. Most investigations on autoimmune pancreatitis (AIP) were published on Asian cohorts while those on Caucasians are limited. However, there might be differences related to the origin. Patients and Methods. We analyzed 36 patients and compared type 1 (AIP1) with type 2 (AIP2). Results. The majority of patients suffered from AIP1 (55.6%). AIP1 patients were significantly older than AIP2 patients (54.4 versus 40.8 years). Moreover, 85.0% of AIP1 patients had concurrent autoimmune cholangitis (AIC) while 18.8% of AIP2 patients suffered from overlap to ulcerative colitis (UC). However, AIP1 patients revealed a cholestatic course and had significantly higher immunoglobulin G4 levels (IgG4). When compared to allele frequencies in healthy controls, in patients with AIP1 HLA-B8 reached statistical significance. Response to steroids was excellent in both groups, but we noticed high rates of relapse especially in AIP1 patients. Finally, 3 patients with AIP1 were diagnosed with cholangiocellular carcinoma (CCC). Conclusion. In contrast to Asian studies, we found an almost equal distribution of AIP1 and AIP2 patients in our German cohort. AIP2 patients were younger and mostly of female gender whereas AIP1 patients revealed higher IgG4 levels and involvement of the biliary tract in sense of IgG4-associated cholangitis.
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Barnes D, Gutiérrez Chacoff J, Benegas M, Perea RJ, de Caralt TM, Ramirez J, Vollmer I, Sanchez M. Central airway pathology: clinic features, CT findings with pathologic and virtual endoscopy correlation. Insights Imaging 2017; 8:255-270. [PMID: 28197883 PMCID: PMC5359148 DOI: 10.1007/s13244-017-0545-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 12/15/2022] Open
Abstract
Objectives To describe the imaging features of the central airway pathology, correlating the findings with those in pathology and virtual endoscopy. To propose a schematic and practical approach to reach diagnoses, placing strong emphasis on multidetector computed tomography (MDCT) findings. Methods We reviewed our thoracic pathology database and the central airway pathology-related literature. Best cases were selected to illustrate the main features of each disease. MDCT was performed in all cases. Multiplanar and volume-rendering reconstructions were obtained when necessary. Virtual endoscopy was obtained from the CT with dedicated software. Results Pathological conditions affecting the central airways are a heterogeneous group of diseases. Focal alterations include benign neoplasms, malignant neoplasms, and non-neoplastic conditions. Diffuse abnormalities are divided into those that produce dilation and those that produce stenosis and tracheobronchomalacia. Direct bronchoscopy (DB) visualises the mucosal layer and is an important diagnostic and therapeutic weapon. However, assessing the deep layers or the adjacent tissue is not possible. MDCT and post-processing techniques such as virtual bronchoscopy (VB) provide an excellent evaluation of the airway wall. Conclusion This review presents the complete spectrum of the central airway pathology with its clinical, pathological and radiological features. Teaching points • Dividing diseases into diffuse and focal lesions helps narrow the differential diagnosis. • Focal lesions with nodularity are more likely to correspond to tumours. • Focal lesions with stenosis are more likely to correspond to inflammatory disease. • Posterior wall involvement is the main feature in diffuse lesions with stenosis.
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Affiliation(s)
- Daniel Barnes
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | | | - Mariana Benegas
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Rosario J Perea
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Teresa M de Caralt
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - José Ramirez
- Pathology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Ivan Vollmer
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Marcelo Sanchez
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Liu QC, Dong F, Pan JF, Zhuang ZH, Gao F, Liu GZ, Chen QQ, Chen S, Weng SH, Lin LQ, Chen JT, Chen M, Wang CD, Lin XH. Antibodies to Type IV Collagen Induce Type 1 Autoimmune Pancreatitis. Inflammation 2017; 39:592-600. [PMID: 26568263 DOI: 10.1007/s10753-015-0284-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Type 1 autoimmune pancreatitis (AIP) is prototypic autoantibody-mediated diseases. Sclerosis accompanied by fiber deposition is generally regarded as the primary lesion in the development of obliterative vasculitis. However, why collagens or their antibodies play a crucial role in the pathogenesis of AIP has not been demonstrated. This study was performed to investigate if anti-collagen type IV antibodies (ACIVAbs) are the key factor of fiber deposition and recruit leukocytes, resulting in obliterative vasculitis in pancreas. Enzyme-linked immunosorbent analyses (ELISA) were used to measure the expression of Col IV and ACIVAbs in serum of patients with and without AIP. In vitro, adhesion and proliferation were determined by human lymphocytes incubated with Col IV and ACIVAbs. In vivo, C57BL0/6 mice were immunized with IgG-ACIVAbs, followed by analysis of clinical phenotype. IgG-ACIVAbs were recognized by the serum specimens from 12 of 22 patients with type 1 AIP, 3 of 9 patients with Crohn's disease, and 2 of 18 patients with pancreatic cancer, but not in healthy controls and acute pancreatitis. In patient's biopsy, ACIVAb staining increased and co-localized with subepithelial IgG4 deposits along the capillary walls and surrounding nerve fibers. In vitro, recombinant IgG-ACIVAbs increased leukocyte adhesion and proliferation. What is more, AIP could be induced in mice by immunization with IgG-ACIVAbs into adult mice.
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Affiliation(s)
- Qi-cai Liu
- Department of Laboratory Medicine, the 1st Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Feng Dong
- Department of Radiation Oncology, the 1st Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Jian-feng Pan
- Department of Pharmacy, the 1st Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Ze-hao Zhuang
- Department of Gastroenterology, the 1st Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Feng Gao
- Department of Pathology, the 1st Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Graduate Education College, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Guo-zhong Liu
- Department of Surgery, the 1st Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Qing-quan Chen
- Medical Technology and Engineering College, Fujian Medical University, Fuzhou, 350005, China
| | - Shu Chen
- Department of Pharmaceutical Analysis, Fujian Medical University, Fuzhou, China
| | - Shao-huang Weng
- Department of Pharmaceutical Analysis, Fujian Medical University, Fuzhou, China
| | - Li-qing Lin
- Department of Pharmaceutical Analysis, Fujian Medical University, Fuzhou, China
| | - Jin-tong Chen
- Department of Gastroenterology, the 1st Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Min Chen
- Department of Laboratory Medicine, Medical Technology and Engineering College, Fujian Medical University, 88 Jiaotong Road, 350004, Fuzhou, China.
| | - Cheng-dan Wang
- Department of Gastroenterology, the 1st Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| | - Xin-hua Lin
- Department of Pharmaceutical Analysis, Fujian Medical University, Fuzhou, China.
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Radotra BD, Aggarwal A, Kapoor A, Singla N, Chatterjee D. An orphan disease: IgG4-related spinal pachymeningitis: report of 2 cases. J Neurosurg Spine 2016; 25:790-794. [DOI: 10.3171/2016.4.spine1674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IgG4-related disease is relatively new disease entity and a rare one, and our knowledge of this entity continues to evolve. It was first described in the pancreas and since then has been described in virtually every organ. Spinal involvement resulting in pachymeningitis is rare, and there are only 8 reported cases of the same to date, with the cervicothoracic spine being the most commonly affected region.
The authors describe 2 cases in which the patients presented with spinal compression resulting in myeloradiculopathy (Case 1) and radiculopathy (Case 2). Imaging of spine in both cases revealed an ill-defined contrast-enhancing lesion at the lumbar level. Preoperatively, a diagnosis of spinal tumor was made, but intraoperatively no spinal tumor was found. The diagnosis was established histopathologically.
The disease has no particular defining features clinically or radiologically and can mimic common spinal tumors. It is important to accurately diagnose this rare entity because of its multisystem involvement and progressive course. Strict treatment guidelines have yet to be formulated. Although histologically this disease can mimic other inflammatory conditions, the presence of storiform fibrosis and an increased number of IgG4-positive plasma cells can help in clarifying the diagnosis.
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Affiliation(s)
| | - Ashish Aggarwal
- 2Neurosurgery, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Ankur Kapoor
- 2Neurosurgery, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Navneet Singla
- 2Neurosurgery, Postgraduate Institution of Medical Education and Research, Chandigarh, India
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Mordal GCE, Hammarström C, Namtvedt T. [A man in his 40s with diabetes, enlarged lacrimal gland and kidney failure]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1820-1823. [PMID: 27883107 DOI: 10.4045/tidsskr.16.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Della-Torre E, Stone JH. “How I manage” IgG4-Related Disease. J Clin Immunol 2016; 36:754-763. [DOI: 10.1007/s10875-016-0331-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 08/29/2016] [Indexed: 12/18/2022]
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Muturi A, Kotecha V, Ojee C, Mang'oka D, Muthuri J. A caecal pseoudotumour with an incidental adenomatoid testicular tumour in a man with right undescended testis: a case report. World J Surg Oncol 2016; 14:236. [PMID: 27585539 PMCID: PMC5009702 DOI: 10.1186/s12957-016-0995-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inflammatory pseudotumour refers to a non-malignant tumour-like mass resulting from an inflammatory reaction that is composed of granulation tissue with leukocyte infiltration that commonly occurs in the paediatric or young adult population. These tumours occur more commonly in the lungs and the orbit but rarely does it affect the gastrointestinal tract. It poses a clinical diagnostic challenge since it is a benign condition than can mimic the malignant counterpart. Our case is a rare presentation of the caecal pseudotumour in the presence of a right undescended abdominal testis evaluated as a caecal tumour with a differential diagnosis of a testicular malignancy. CASE PRESENTATION We report a 53-year-old male who presented with clinical signs suggestive of right colon tumour and undescended right testis. Intra-operatively, a caecal mass was found with no clearly discernable appendix and extensive adhesion of the right colon to the retroperitoneum, to the liver and gall bladder. A testis was found adherent to the posterior aspect of the caecum and terminal ileum. A right hemicolectomy was performed. Histopathology findings revealed an inflammatory mass with abundant fibroblast proliferation and chronic inflammatory cells infiltrate, involving bowel wall and periceacal adipose tissue; no malignant cells were identified. The testis had within it an adenomatoid tumour nodule. He had uneventful recovery and was discharged home 7 days post-operatively. At the moment, he is symptoms free. CONCLUSIONS The occurrence of right colonic inflammatory pseudotumour and co-existent adenomatoid testicular tumour arising from a cryptorchid testis is very unusual. This would make one incline towards a malignant testicular lesion in the presence of cryptorchidism. Testicular adenomatoid tumour is a rare benign neoplasm, mostly affecting fully descended testis and usually does not warrant orchidectomy for purposes of preserving testicular function. On the other hand, surgical resection remains the only safe and curative treatment option available for inflammatory pseudotumours.
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Allen SG, Soliman AS, Toy K, Omar OS, Youssef T, Karkouri M, Ayad E, Abdel-Aziz A, Hablas A, Tahri A, Oltean HN, Kleer CG, Merajver SD. Chronic Mastitis in Egypt and Morocco: Differentiating between Idiopathic Granulomatous Mastitis and IgG4-Related Disease. Breast J 2016; 22:501-9. [PMID: 27279578 PMCID: PMC5007188 DOI: 10.1111/tbj.12628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is a benign, frequently severe chronic inflammatory lesion of the breast. Its etiology remains unknown and reported cases vary in their presentation and histologic findings with an optimal treatment algorithm yet to be described owing mainly to the disease's heterogeneity. IgG4‐related disease (IgG4‐RD) is a newly recognized systemic fibroinflammatory condition characterized by a dense lymphoplasmacytic infiltrate with many IgG4‐positive plasma cells, storiform fibrosis, and obliterative phlebitis. Immunosuppressive therapy is considered to be an effective first‐line therapy for IgG4‐RD. We sought to clarify and classify chronic mastitis according to the histologic findings of IgG4‐RD mastitis with respect to IGM and to develop a robust diagnostic framework to help select patients for optimal treatment strategies. Using the largest collection to date (43 cases from Egypt and Morocco), we show that despite sharing many features, IGM and IgG4‐RD mastitis are separate diseases. To diagnostically separate the diseases, we created a classification schema—termed the Michigan Classification—based upon our large series of cases, the consensus statement on IgG4‐RD, and the histologic description of IGM in the literature. Using our classification, we discerned 17 cases of IgG4‐RD and 8 cases of IGM among the 43 chronic mastitis cases, with 18 indeterminate cases. Thus, our Michigan Classification can form the basis of rational stratification of chronic mastitis patients between these two clinically and histopathologically heterogeneous diseases.
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Affiliation(s)
- Steven G Allen
- Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Amr S Soliman
- Epidemiology, University of Nebraska, Omaha, Nebraska
| | - Kathleen Toy
- Pathology, University of Michigan, Ann Arbor, Michigan
| | | | - Tamer Youssef
- Surgical Oncology, Mansoura University, Mansoura, Egypt
| | - Mehdi Karkouri
- Pathology, Hassan the Second University, Casablanca, Morocco
| | - Essam Ayad
- Pathology, Cairo University, Cairo, Egypt
| | | | | | - Ali Tahri
- Centre Hospitalier Universitaire-Mohamed VI, Marrakesh, Morocco
| | - Hanna N Oltean
- Epidemiology, University of Michigan, Ann Arbor, Michigan
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Choi SB, Lim CH, Cha MG, Kang WK. IgG4-related disease of the rectum. Ann Surg Treat Res 2016; 90:292-5. [PMID: 27186575 PMCID: PMC4865708 DOI: 10.4174/astr.2016.90.5.292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/02/2016] [Indexed: 02/08/2023] Open
Abstract
IgG4-related disease is a relatively new disease entity characterized by elevated serum IgG4 levels and marked infiltration of IgG4-positive plasma cells in lesions. Organ enlargement or nodular lesions consisting of abundant infiltration of lymphocytes and IgG4-positive plasma cells and fibrosis are seen in various organs throughout. We encountered a patient with an inflammatory pseudotumor of the rectum, which was histopathologically confirmed to be an IgG4-related disease. The patient was a 28-year-old woman who had constipation for 3 months. The endoluminal ultrasonography showed a lesion that was heterogeneous and low echogenic in lower rectum. The result of colonoscopic biopsy findings was of chronic proctitis with lymphoid aggregates. For a confirmative diagnosis, excision was performed. Histopathological examination represented plasma cell infiltration and fibrosis. Immunohistochemistry revealed prominence of IgG4-positive plasma cells and confirmed the diagnosis of IgG4-related disease. The patient is currently under observation on low-dose oral prednisolone without relapse.
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Affiliation(s)
- Sung-Bong Choi
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul-Hyun Lim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Guen Cha
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Kyung Kang
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Moghaddam PA, Virk R, Sakhdari A, Prasad ML, Cosar EF, Khan A. Five Top Stories in Thyroid Pathology. Arch Pathol Lab Med 2016; 140:158-70. [PMID: 26910221 DOI: 10.5858/arpa.2014-0468-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Thyroid carcinoma is the most common malignant tumor of endocrine organs, yet it only accounts for approximately 1% of all cancers in the United States with more than 35,000 new cases diagnosed each year and more than 450,000 people living with this disease. While most tumors can be diagnosed without much difficulty, a few tumor types, especially tumors with follicular pattern, sometimes pose a diagnostic challenge. OBJECTIVE To discuss morphologic, immunohistochemical, and molecular features of thyroid tumors. We also explore the clinicopathologic features of papillary microcarcinoma and medullary microcarcinoma and how the latter is related and differentiated from C-cell hyperplasia. Finally with the ever-growing list of organ systems involved in immunoglobulin (Ig) G4-related diseases, we discuss the still not completely explored IgG-4-related thyroid disease. DATA SOURCES Data were obtained from review of the pertinent peer-reviewed literature and institutional experience. CONCLUSIONS Histomorphologic evaluation still remains the gold standard for diagnosis in most cases of thyroid diseases. The application of ancillary studies such as immunohistochemistry and molecular diagnosis, including next-generation sequencing, is becoming more common.
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Affiliation(s)
- Parnian Ahmadi Moghaddam
- From the Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester (Drs Moghaddam, Sakhdari, Cosar, and Khan)
| | - Renu Virk
- and the Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Drs Virk and Prasad)
| | - Ali Sakhdari
- From the Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester (Drs Moghaddam, Sakhdari, Cosar, and Khan)
| | - Manju L Prasad
- and the Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Drs Virk and Prasad)
| | - Ediz F Cosar
- From the Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester (Drs Moghaddam, Sakhdari, Cosar, and Khan)
| | - Ashraf Khan
- From the Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester (Drs Moghaddam, Sakhdari, Cosar, and Khan)
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Li W, Xie XY, Su JZ, Hong X, Chen Y, Gao Y, Zhang ZY, Yu GY. Ultrasonographic Features of Immunoglobulin G4-Related Sialadenitis. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:167-175. [PMID: 26518180 DOI: 10.1016/j.ultrasmedbio.2015.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/31/2015] [Accepted: 09/14/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to determine the role of ultrasonography in the diagnosis and follow-up evaluation of immunoglobulin G4-related sialadenitis. In this study, 42 patients with immunoglobulin G4-related sialadenitis underwent ultrasonography of the parotid and submandibular glands, and the sonographic appearance was compared with the pathologic findings. Post-treatment ultrasonographic appearance was compared with the pre-treatment findings in 30 patients who received immunomodulatory therapy. The ultrasonographic appearance of the affected glands was divided into five patterns: superficial hypo-echoic, multiple hypo-echoic foci, whole-gland heterogeneity, space occupying and normal echo. Histopathologic examination revealed marked lymphoplasmacytic inflammation and inter-lobular fibrosis, which were more severe in the superficial than deep portion of the affected glands. After treatment, the volume of the affected gland decreased significantly, the internal echo became more homogeneous and the superficial hypo-echoic area disappeared or was reduced. In conclusion, ultrasonography may play an important role in the diagnosis and follow-up evaluation of immunoglobulin G4-related sialadenitis.
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Affiliation(s)
- Wei Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao-Yan Xie
- Department of Oral Radiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jia-Zeng Su
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xia Hong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Chen
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Gao
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zu-Yan Zhang
- Department of Oral Radiology, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Primary and secondary disease of the peritoneum and mesentery: review of anatomy and imaging features. ACTA ACUST UNITED AC 2015; 40:626-42. [PMID: 25189130 DOI: 10.1007/s00261-014-0232-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The largest and most complex serosal membrane in the body, the peritoneum, lines the abdominal cavity, and the abdominopelvic viscera. It is frequently involved in a variety of benign and malignant processes. While secondary involvement of the peritoneum is more common, primary tumors can be a diagnostic challenge. Knowledge of the anatomy is crucial in understanding the various pathologic processes. Cross-sectional imaging plays an important role in diagnosing and evaluating the extent of the disease processes. This article reviews the imaging anatomy of the peritoneum and mesentery and the common pathologies involving it.
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Tomoda T, Nouso K, Kato H, Miyahara K, Dohi C, Morimoto Y, Kinugasa H, Akimoto Y, Matsumoto K, Yamamoto N, Noma Y, Horiguchi S, Tsutsumi K, Amano M, Nishimura SI, Yamamoto K. Alteration of serum N-glycan profile in patients with autoimmune pancreatitis. Pancreatology 2015; 16:44-51. [PMID: 26723536 DOI: 10.1016/j.pan.2015.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 10/06/2015] [Accepted: 11/10/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aims of this study were to determine the change in whole-serum N-glycan profile in autoimmune pancreatitis (AIP) patients and to investigate its clinical utility. METHODS We collected serum from 21 AIP patients before any treatment, and from 60 healthy volunteers (HLTs). Serum glycan profile was measured by comprehensive and quantitative high-throughput glycome analysis. RESULTS Of the 53 glycans detected, 14 were differentially expressed in AIP patients. Pathway analysis demonstrated that agalactosyl and monogalactosyl bi-antennary glycans were elevated in AIP patients. Among the 14 glycans, #3410, #3510, and #4510 showed high area under receiver operating characteristic (AUROC) values (0.955, 0.964, and 0.968 respectively) for the diagnosis of AIP. These three glycans were mainly bound to immunoglobulin G; however, their serum levels were significantly higher, even in AIP patients who showed lower serum IgG4 levels, than in HLTs. CONCLUSIONS We demonstrated, for the first time, whole-serum glycan profiles of AIP patients and showed that the levels of glycans #3410, #3510, and #4510 were increased in AIP patients. These glycans might be valuable biomarkers of AIP.
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Affiliation(s)
- Takeshi Tomoda
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Kazuhiro Nouso
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hironari Kato
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Miyahara
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Chihiro Dohi
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Morimoto
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hideaki Kinugasa
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yutaka Akimoto
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuyuki Matsumoto
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Naoki Yamamoto
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Noma
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Shigeru Horiguchi
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koichiro Tsutsumi
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Maho Amano
- Field of Drug Discovery Research, Faculty of Advanced Life Science & Graduate School of Life Science, Hokkaido University, Sapporo, Hokkaido, Japan; Medicinal Chemistry Pharmaceuticals, Co., Ltd., Sapporo, Hokkaido, Japan
| | - Shin-Ichiro Nishimura
- Field of Drug Discovery Research, Faculty of Advanced Life Science & Graduate School of Life Science, Hokkaido University, Sapporo, Hokkaido, Japan; Medicinal Chemistry Pharmaceuticals, Co., Ltd., Sapporo, Hokkaido, Japan
| | - Kazuhide Yamamoto
- Departments of Gastroenterology & Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Rasch S, Phillip V, Schmid RM, Algül H. Epidemiology, clinical presentation, diagnosis and treatment of autoimmune pancreatitis: A retrospective analysis of 53 patients. Pancreatology 2015; 16:73-7. [PMID: 26694138 DOI: 10.1016/j.pan.2015.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/03/2015] [Accepted: 11/17/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Most of the data about epidemiology, clinical presentation and treatment of autoimmune pancreatitis (AIP) is based on case series or small study groups. We therefore analyzed all cases of AIP treated at our clinic retrospectively. METHODS We searched our clinical database for the diagnosis pancreatitis between January 2007 and June 2014, selected patients with AIP and entered all relevant information in a database for statistical analysis. RESULTS In total 53 patients with AIP were treated at our institution, 62% with type 1 and 23% with type 2 AIP. Gender distribution was male/female 3.1:1 for type 1 and 1:1.2 for type 2 AIP. The median age was 63.0 and 32.5 years for type 1 and type 2 AIP, respectively. The most common symptom is abdominal pain particular in patients with type 2 AIP whereas jaundice was only apparent in patients with type 1 AIP. The international diagnostic criteria seem to facilitate diagnosis of AIP as unnecessary pancreatic surgery in patients with AIP decreases. In 62.6% of the patients therapy was indicated and 84.8% showed a response to initial therapy with steroids. Recurring disease occurred in 28.3% of the cases but only 3.8% suffered a second relapse. Permanent maintenance therapy with steroids or additional therapy with immunomodulatory drugs is successful in recurring disease. CONCLUSION Our data further corroborate previous findings on epidemiology, clinical presentation and treatment of AIP. AIP is a well manageable autoimmune disease in most patients. Better biopsy techniques and simplified diagnostic criteria might further alleviate diagnosis of AIP.
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Affiliation(s)
- Sebastian Rasch
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.
| | - Veit Phillip
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Roland M Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Hana Algül
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany
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Courcet E, Beltjens F, Charon-Barra C, Guy F, Orry D, Ghiringhelli F, Arnould L. [An IgG4-related pancreatitis mimicking an adenocarcinoma: A case report]. Ann Pathol 2015; 35:511-4. [PMID: 26596693 DOI: 10.1016/j.annpat.2015.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 05/22/2015] [Accepted: 05/31/2015] [Indexed: 12/29/2022]
Abstract
Type 1 auto-immune pancreatitis (type 1 AIP) is the pancreatic manifestation of IgG4-related systemic disease (IgG4-RD). This disease has recently been individualized and is characterized by elevated serum IgG4 levels and extrapancreatic lesions with common histologic characteristic: dense infiltration of lymphocytes, IgG4-positive plasma cells and storiforme fibrosis. Obliterative phlebitis is frequently detected. The pancreas is frequently involved in this disease. As approach to the pancreas for histological examination is generally difficult, AIP is diagnosed using a combination of clinical, serological, morphological and histopathological features. In pseudotumoral cases, AIP can be misdiagnosed as pancreatic cancer. Since AIP responds dramatically to steroid therapy, accurate diagnosis of AIP can avoid unnecessary laparotomy or pancreatic resection. We report here a case of a patient who underwent surgery for presumed pancreatic cancer. The final diagnosis was type 1 AIP.
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Affiliation(s)
- Emilie Courcet
- Département de biologie et pathologie des tumeurs, service d'anatomie et cytologie pathologiques, CLCC Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France.
| | - Françoise Beltjens
- Département de biologie et pathologie des tumeurs, service d'anatomie et cytologie pathologiques, CLCC Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France
| | - Céline Charon-Barra
- Département de biologie et pathologie des tumeurs, service d'anatomie et cytologie pathologiques, CLCC Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France
| | - France Guy
- Département de radiologie, CLCC Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France
| | - David Orry
- Département de chirurgie, CLCC Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France
| | - François Ghiringhelli
- Département d'oncologie, CLCC Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France
| | - Laurent Arnould
- Département de biologie et pathologie des tumeurs, service d'anatomie et cytologie pathologiques, CLCC Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France
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Alidjan FM, Karim F, Verdijk RM, van Esser JW, van Heerde MJ. A Patient with Autoimmune Pancreatitis Type 1 with Previously Known Lymphadenopathy, Both in the Context of IgG4-related Disease. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:790-3. [PMID: 26537530 PMCID: PMC4642366 DOI: 10.12659/ajcr.895059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patient: Male, 62 Final Diagnosis: Auto-immune pancreatitis Symptoms: Jaundice • lymfadenopathy Medication: — Clinical Procedure: Laboratory • imaging Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Fazil M Alidjan
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Faiz Karim
- Department of Internal Medicine, Erasmus Medical Centre, Rottterdam, Netherlands
| | - Rob M Verdijk
- Department of Pathology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Joost W van Esser
- Department of Internal Medicine and Gastroenterology, Amphia Hospital, Breda, Netherlands
| | - Marianne J van Heerde
- Department of Internal Medicine and Gastroenterology, Amphia Hospital, Breda, Netherlands
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50
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Iwasaki S, Kamisawa T, Koizumi S, Chiba K, Tabata T, Kuruma S, Kuwata G, Fujiwara T, Koizumi K, Arakawa T, Momma K, Hara S, Igarashi Y. Characteristic findings of endoscopic retrograde cholangiopancreatography in autoimmune pancreatitis. Gut Liver 2015; 9:113-7. [PMID: 25167792 PMCID: PMC4282851 DOI: 10.5009/gnl13473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background/Aims Diffuse or segmental irregular narrowing of the main pancreatic duct (MPD), as observed by endoscopic retrograde cholangiopancreatography (ERCP), is a characteristic feature of autoimmune pancreatitis (AIP). Methods ERCP findings were retrospectively examined in 40 patients with AIP in whom irregular narrowing of the MPD was detected near the orifice. The MPD opening sign was defined as the MPD within 1.5 cm from the orifice being maintained. The distal common bile duct (CBD) sign was defined as the distal CBD within 1.5 cm from the orifice being maintained. Endoscopic findings of a swollen major papilla and histological findings of specimens obtained from the major papilla were examined in 26 and 21 patients, respectively. Results The MPD opening sign was detected in 26 of the 40 patients (65%). The distal CBD sign was detected in 25 of the 32 patients (78%), which showed stenosis of the lower bile duct. The patients who showed the MPD opening sign frequently showed the distal CBD sign (p=0.018). Lymphoplasmacytic infiltration, but not dense fibrosis, was histologically detected in biopsy specimens obtained from the major papilla. Conclusions On ERCP, the MPD and CBD adjacent to the major papilla are frequently maintained in patients with AIP involving the pancreatic head. These signs are useful for diagnosing AIP on ERCP.
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Affiliation(s)
- Susumu Iwasaki
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, and Division of Gastroenterology and Hepatology, Omori Medical Center, Toho University School of Medicine, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Satomi Koizumi
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Kazuro Chiba
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Taku Tabata
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Sawako Kuruma
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Go Kuwata
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takashi Fujiwara
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Koichi Koizumi
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takeo Arakawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Kumiko Momma
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Seiichi Hara
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Omori Medical Center, Toho University School of Medicine, Tokyo, Japan
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