Seo Ho Seok, Jung Yoon Ju, Park Cho Hyun, Song Kyo Young, Jung Eun Sun
Division of Gastrointestinal Surgery, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Gastric Cancer. 2018 Mar;18(1):99-107. doi: 10.5230/jgc.2018.18.e8. Epub 2018 Mar 28.
Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibro-inflammatory disorder characterized by specific pathological findings and elevated serum IgG4 level. IgG4-RD in the stomach is rare, and occasionally diagnosed as gastric subepithelial tumor (SET) by endoscopy or computed tomography scan. Two female patients in the age group of 40-50 years were diagnosed with 4 cm sized gastric SET. One underwent laparoscopic gastric wedge resection. Another one had a history of subtotal gastrectomy for early gastric cancer and idiopathic thrombocytopenic purpura with oral steroids administration. She underwent a completion total gastrectomy with splenectomy for the gastric SET and ITP. The pathology showed storiform fibrosis, and IgG4 was positive in immunohistochemistry (IHC) stain. IgG4-RD is known as a medical disease that could be treated with oral steroids. The difficulty in preoperative diagnosis of the disease occasionally causes unnecessary gastric resection. Thus, preoperative diagnostic methods for IgG4-RD such as deep biopsy with IHC stain or magnetic resonance imaging are needed.
免疫球蛋白G4相关性疾病（IgG4-RD）是一种免疫介导的纤维炎症性疾病，其特征为特定的病理表现和血清IgG4水平升高。胃IgG4-RD较为罕见，在内镜检查或计算机断层扫描时偶尔会被诊断为胃黏膜下肿瘤（SET）。两名年龄在40至50岁之间的女性患者被诊断出患有4厘米大小的胃SET。其中一名接受了腹腔镜胃楔形切除术。另一名患者曾因早期胃癌和特发性血小板减少性紫癜接受过胃大部切除术，并口服过类固醇。她因胃SET和ITP接受了全胃切除术及脾切除术。病理显示为席纹状纤维化，免疫组织化学（IHC）染色IgG4呈阳性。IgG4-RD是一种可用口服类固醇治疗的疾病。该疾病术前诊断困难，偶尔会导致不必要的胃切除术。因此，需要如IHC染色深度活检或磁共振成像等IgG4-RD的术前诊断方法。
