Wu Po-Hsuan, Chang Yu-Chen, Liao Li-Jen
Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.
Department of Pathology, Far Eastern Memorial Hospital, Taipei, Taiwan.
J Med Ultrasound. 2019 Jan-Mar;27(1):43-46. doi: 10.4103/JMU.JMU_66_18. Epub 2018 Oct 30.
Cervical lymph node enlargement as the first and sole manifestation of IgG4-related disease (IgG4-RD) is rare and is often difficult to distinguish from lymphoma. Here, we report a case of a 63-year-old man initially presenting with bilateral posterior neck masses. Ultrasonography revealed multiple matted, ovoid, homogenous, hypoechoic, and enlarged lymph nodes below the right parotid gland. In addition, there was heterogeneous echotexture with small and indistinct hypoechoic nodules over bilateral parotid and submandibular glands which suggested sclerosing sialadenitis. Pathology of the tissues obtained by core needle biopsy revealed reactive hyperplasia, but a diagnosis of lymphoma could not be excluded. Subsequently, excisional biopsy and serological tests were done. The diagnosis of IgG4-RD was confirmed due to marked elevation of serum IgG4 levels and pathological evidence of IgG+ and IgG4+ plasma cell infiltration in the lymph node specimen. The patient's neck masses subsided gradually after 1 week of oral steroid therapy. The differential diagnosis of IgG4-RD should always be considered when sclerosing sialadenitis is presented with cervical lymphadenopathy.
颈淋巴结肿大作为IgG4相关性疾病（IgG4-RD）的首发及唯一表现较为罕见，且常难以与淋巴瘤相鉴别。在此，我们报告一例63岁男性患者，最初表现为双侧颈部后侧肿块。超声检查显示右腮腺下方有多个相互融合的、椭圆形、均匀的、低回声且肿大的淋巴结。此外，双侧腮腺和颌下腺回声不均匀，有小而不清晰的低回声结节，提示硬化性涎腺炎。粗针穿刺活检获取的组织病理显示为反应性增生，但不能排除淋巴瘤诊断。随后进行了切除活检及血清学检查。由于血清IgG4水平显著升高以及淋巴结标本中IgG +和IgG4 +浆细胞浸润的病理证据，确诊为IgG4-RD。口服类固醇治疗1周后，患者颈部肿块逐渐消退。当硬化性涎腺炎伴有颈淋巴结病时，应始终考虑IgG4-RD的鉴别诊断。
