IgG4 inflammatory pseudotumor mimicking primary lung cancer : a case report
Introduction IgG4 related disease (IgG4-RTD) is an infrequent disease with possible multiple organ involvement. It is characteristic to find inflammatory nodules with IgG4 positive plasma cell infiltration, storiform fibrosis and obliterative phlebitis. We present a patient with an inflammatory pseu...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2023
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/34753 |
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I10-R327-article-34753 |
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Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Inglés |
| format |
Artículo revista |
| topic |
immunoglobulin g4-related disease plasma cell granuloma lung neoplasms granuloma de células plasmáticas neoplasias pulmonares enfermedad relacionada con inmunoglobulina g4 neoplasias pulmonares doença relacionada a imunoglobulina g4 granuloma de células plasmáticas |
| spellingShingle |
immunoglobulin g4-related disease plasma cell granuloma lung neoplasms granuloma de células plasmáticas neoplasias pulmonares enfermedad relacionada con inmunoglobulina g4 neoplasias pulmonares doença relacionada a imunoglobulina g4 granuloma de células plasmáticas Seip, Tomás Calderón Novoa, Francisco Valeo Chulvi, Melina Paula Smith, David Dietrich, Agustin IgG4 inflammatory pseudotumor mimicking primary lung cancer : a case report |
| topic_facet |
immunoglobulin g4-related disease plasma cell granuloma lung neoplasms granuloma de células plasmáticas neoplasias pulmonares enfermedad relacionada con inmunoglobulina g4 neoplasias pulmonares doença relacionada a imunoglobulina g4 granuloma de células plasmáticas |
| author |
Seip, Tomás Calderón Novoa, Francisco Valeo Chulvi, Melina Paula Smith, David Dietrich, Agustin |
| author_facet |
Seip, Tomás Calderón Novoa, Francisco Valeo Chulvi, Melina Paula Smith, David Dietrich, Agustin |
| author_sort |
Seip, Tomás |
| title |
IgG4 inflammatory pseudotumor mimicking primary lung cancer : a case report |
| title_short |
IgG4 inflammatory pseudotumor mimicking primary lung cancer : a case report |
| title_full |
IgG4 inflammatory pseudotumor mimicking primary lung cancer : a case report |
| title_fullStr |
IgG4 inflammatory pseudotumor mimicking primary lung cancer : a case report |
| title_full_unstemmed |
IgG4 inflammatory pseudotumor mimicking primary lung cancer : a case report |
| title_sort |
igg4 inflammatory pseudotumor mimicking primary lung cancer : a case report |
| description |
Introduction
IgG4 related disease (IgG4-RTD) is an infrequent disease with possible multiple organ involvement. It is characteristic to find inflammatory nodules with IgG4 positive plasma cell infiltration, storiform fibrosis and obliterative phlebitis. We present a patient with an inflammatory pseudotumor in the right upper lobe, mimicking a primary lung tumor.
Case report
Our patient, a 48-year old heavy smoker (25 pack/year) with no relevant medical background, referred chest pain, non-productive cough and sporadic nightly fever. Image findings revealed a mass in the right upper lobe, with increased SUV in PET-scan, and mediastinal lymphadenopathies. Primary lung tumor was suspected and right upper lobectomy was performed. Due to absence of cellular atypia and the intense plasmacytic activity in the lesion, immunohistochemical analysis was performed: abundant IgG4 plasma cells were identified, with a IgG4/IgG relation of 74%. Diagnosis of IgG4- inflammatory pseudotumor was made.
Discussion
After an extensive bibliographic review, we found just one similar case reported with an IgG4-lung pseudotumor without systemic disease.
Due to the broad spectrum of clinical features of IgG4-RTD, and the potential multiple organ involvement, it is hard to find a classification and diagnostic criteria with high sensitivity and specificity, nevertheless they can be useful in clinical practice.
Conclusion
There are several benign inflammatory diseases which can mimic a primary lung tumor. Although incidence is low, IgG4 pseudotumor should be considered as a differential diagnosis in the absence of malignancy. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2023 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/34753 |
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I10-R327-article-347532023-07-10T12:03:20Z IgG4 inflammatory pseudotumor mimicking primary lung cancer : a case report Reporte de caso: pseudotumor inflamatorio por IgG4 simulando cáncer de pulmón Pseudotumor inflamatório IgG4 simulando câncer de pulmão: relato de caso Seip, Tomás Calderón Novoa, Francisco Valeo Chulvi, Melina Paula Smith, David Dietrich, Agustin immunoglobulin g4-related disease plasma cell granuloma lung neoplasms granuloma de células plasmáticas neoplasias pulmonares enfermedad relacionada con inmunoglobulina g4 neoplasias pulmonares doença relacionada a imunoglobulina g4 granuloma de células plasmáticas Introduction IgG4 related disease (IgG4-RTD) is an infrequent disease with possible multiple organ involvement. It is characteristic to find inflammatory nodules with IgG4 positive plasma cell infiltration, storiform fibrosis and obliterative phlebitis. We present a patient with an inflammatory pseudotumor in the right upper lobe, mimicking a primary lung tumor. Case report Our patient, a 48-year old heavy smoker (25 pack/year) with no relevant medical background, referred chest pain, non-productive cough and sporadic nightly fever. Image findings revealed a mass in the right upper lobe, with increased SUV in PET-scan, and mediastinal lymphadenopathies. Primary lung tumor was suspected and right upper lobectomy was performed. Due to absence of cellular atypia and the intense plasmacytic activity in the lesion, immunohistochemical analysis was performed: abundant IgG4 plasma cells were identified, with a IgG4/IgG relation of 74%. Diagnosis of IgG4- inflammatory pseudotumor was made. Discussion After an extensive bibliographic review, we found just one similar case reported with an IgG4-lung pseudotumor without systemic disease. Due to the broad spectrum of clinical features of IgG4-RTD, and the potential multiple organ involvement, it is hard to find a classification and diagnostic criteria with high sensitivity and specificity, nevertheless they can be useful in clinical practice. Conclusion There are several benign inflammatory diseases which can mimic a primary lung tumor. Although incidence is low, IgG4 pseudotumor should be considered as a differential diagnosis in the absence of malignancy. Introducción La enfermedad relacionada con IgG4 (IgG4-RTD) es una enfermedad poco frecuente con posible afectación multiorgánica. La presencia de infiltrados linfoplasmocitarios con células plasmáticas positivas para IgG4, fibrosis y flebitis obliterante. Presentamos el caso de un paciente con un pseudotumor inflamatorio en el lóbulo superior derecho, con presentación clínica compatible con tumor primario de pulmón. Caso clínico Nuestro paciente de 48 años de edad, tabaquista severo (25 paquetes / año) sin antecedentes médicos relevantes, consulta por dolor torácico, tos no productiva y registros subfebriles aislados. Presenta una masa en el lóbulo superior derecho en estudio por imagen, con aumento de la captación en el PET, asociado a adenopatías mediastínicas. Con diagnóstico inicial de cáncer de pulmón, se realizó lobectomía superior derecha. Debido a la ausencia de atipia celular y la presencia de infiltrados linfoplasmocitarios en la lesión, se realizó análisis inmunohistoquímico: se identificaron abundantes células plasmáticas positivas para IgG4, con una relación IgG4 / IgG del 74%. Se realizó el diagnóstico de pseudotumor inflamatorio por IgG4. Discusión Tras una extensa revisión bibliográfica, sólo encontramos un caso similar, de una paciente con un pseudotumor pulmonar IgG4 sin enfermedad sistémica. Debido a la variabilidad de la presentación clínica de la enfermedad relacionada a IgG4, y su potencial afectación multiorgánica, es difícil encontrar una clasificación y criterios diagnósticos con alta sensibilidad y especificidad, sin embargo estos suelen ser útiles en la práctica clínica. Conclusión Múltiples enfermedades inflamatorias son diagnóstico diferencial de tumor primario de pulmón. Si bien la incidencia es baja, el pseudotumor IgG4 debe considerarse como un diagnóstico diferencial cuando no hay evidencia de enfermedad neoplásica. Introdução A doença relacionada com IgG4 (IgG4-RTD) é uma doença infrequente com possível envolvimento de múltiplos órgãos. É característico encontrar nódulos inflamatórios com infiltração de células plasmáticas positivas para IgG4, fibrose estoriforme e flebite obliterativa. Apresentamos um paciente com pseudotumor inflamatório no lobo superior direito, simulando ser um tumor primário de pulmão. Relato de caso Nosso paciente, fumador, faz mais de 48 anos (25 maços / ano) sem história médica relevante, referia dor no peito, tosse não produtiva e febre noturna esporádica. As imagens revelaram uma massa no lobo superior direito, com SUV aumentado no PET-scan e linfadenopatias mediastinais. Suspeitou-se de um tumor primário de pulmão e realizou-se lobectomia superior direita. Devido à ausência de atipia celular e à intensa atividade plasmocítica na lesão, a peça foi estudada com análise imunoistoquímica: foram identificados plasmócitos IgG4 + abundantes, com relação IgG4 / IgG de 74%. Chegou-se ao diagnóstico de pseudotumor inflamatório por IgG4. Discussão Após uma extensa revisão bibliográfica, encontramos apenas um registro semelhante relatado com um pseudotumor de pulmão IgG4 sem doença sistêmica. Devido ao amplo espectro de características clínicas do IgG4-RTD e ao potencial envolvimento de múltiplos órgãos, é difícil encontrar uma classificação e critérios diagnósticos com alta sensibilidade e especificidade; no entanto, eles podem ser úteis na prática clínica. Conclusão Existem várias doenças inflamatórias benignas que podem mimetizar um tumor pulmonar primário. Embora a incidência seja baixa, o pseudotumor de IgG4 deve ser considerado como diagnóstico diferencial na ausência de malignidade. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2023-03-31 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion text texto texto text/html application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/34753 10.31053/1853.0605.v80.n1.34753 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 80 No. 1 (2023); 66-69 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 80 Núm. 1 (2023); 66-69 Revista da Faculdade de Ciências Médicas de Córdoba; v. 80 n. 1 (2023); 66-69 1853-0605 0014-6722 10.31053/1853.0605.v80.n1 eng https://revistas.unc.edu.ar/index.php/med/article/view/34753/41011 https://revistas.unc.edu.ar/index.php/med/article/view/34753/41028 Derechos de autor 2023 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |