Erschienen in:
01.12.2015 | Case Report
A case of IgG4-related mesenteritis
verfasst von:
Erika Mori, Terumi Kamisawa, Taku Tabata, Satomi Shibata, Kazuro Chiba, Sawako Kuruma, Go Kuwata, Tomoko Onishi, Takashi Fujiwara, Junko Fujiwara, Takeo Arakawa, Kumiko Momma, Koichi Koizumi, Hiroshi Matsumoto, Shinichiro Horiguchi
Erschienen in:
Clinical Journal of Gastroenterology
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Ausgabe 6/2015
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Abstract
IgG4-related disease is a newly recognized fibroinflammatory condition characterized by tumefaction consisting of fibrosis with dense infiltration of IgG4-positive plasma cells; affecting various organs. A case of IgG4-related sclerosing mesenteritis is reported. A 64-year-old man was admitted to our hospital with a suspected tumor of the small intestine. Abdominal computed tomography demonstrated a 6-cm soft tissue mass in the right lower mesentery compressing the jejunum, which also showed accumulation of fluorodeoxyglucose uptake on fluorine-18 fluorodeoxyglucose positron emission tomography. With a preoperative diagnosis of suspected malignant lymphoma with lymphadenopathy in the mesentery, partial small bowel resection was performed. Macroscopically, a hard mass, including several swollen lymph nodes, was detected in the mesentery. Microscopically, marked fibrosis showing partially storiform pattern, obstructive phlebitis, follicular hyperplasia, and abundant infiltration of IgG4-positive plasma cells were detected. IgG4-related mesenteritis was diagnosed histopathologically, but the serum IgG4 level was 81 mg/dl postoperatively. Five months after the surgery, an 11-cm soft tissue mass involving the left ureter appeared. Histological examination of a biopsy specimen from the retroperitoneal mass showed fibrosis with inflammatory infiltration. Although IgG4-related retroperitoneal fibrosis could not be confirmed histologically, the tumor responded well to steroid therapy.