Ishikawa Hiroki, Uruga Hironori, Fujii Takeshi, Kurosaki Atsuko, Morokawa Nasa, Takaya Hisashi
Department of Respiratory Medicine Toranomon Hospital Kajigaya Kawasaki Japan.
Department of Respiratory Medicine, Respiratory Center Toranomon Hospital Tokyo Japan.
Respirol Case Rep. 2020 Mar 10;8(4):e00550. doi: 10.1002/rcr2.550. eCollection 2020 May.
IgG4-related disease is an evolving entity of immune-mediated origin. We report a case of IgG4-related disease mimicking lung cancer with pleural dissemination. A 76-year-old male non-smoker was admitted to our hospital because of chest X-ray abnormality. Chest computed tomography scan showed a lung nodule measuring 26 × 14 mm with tiny nodules on the adjacent pleural surface. Wedge resection by video-assisted thoracoscopic surgery (VATS) was performed to aid diagnosis. Pathological findings of the nodule consisted of lymphoid follicular hyperplasia with lymphoplasmacytic infiltrate, fibrosis, and obstructive vasculitis. Focal and scattered thickening of the pleura with lymphoplasmacytic infiltrate was also observed. The IgG4/IgG ratio in the most prominent area exceeded 80%. Thus, we made a diagnosis of IgG4-related lung and pleural disease. To our knowledge, there has been no report of IgG4-related lung disease mimicking lung cancer with pleural dissemination.
IgG4相关疾病是一种免疫介导起源的不断演变的疾病实体。我们报告一例模拟肺癌伴胸膜播散的IgG4相关疾病病例。一名76岁的男性非吸烟者因胸部X线异常入住我院。胸部计算机断层扫描显示一个大小为26×14mm的肺结节，相邻胸膜表面有小结节。通过电视辅助胸腔镜手术（VATS）进行楔形切除以辅助诊断。结节的病理结果包括淋巴滤泡增生伴淋巴浆细胞浸润、纤维化和阻塞性血管炎。还观察到胸膜局灶性和散在性增厚伴淋巴浆细胞浸润。最显著区域的IgG4/IgG比值超过80%。因此，我们诊断为IgG4相关的肺和胸膜疾病。据我们所知，尚无模拟肺癌伴胸膜播散的IgG4相关肺病的报告。
