Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, 400012, Mumbai, India.
Division of Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, 400012, Mumbai, India.
Clin J Gastroenterol. 2020 Oct;13(5):806-811. doi: 10.1007/s12328-020-01168-7. Epub 2020 Jun 28.
Immunoglobulin G4 (IgG4)-related disease is a multi-organ immune-mediated condition that can mimic many inflammatory, malignant, and infectious disorders. Isolated IgG4-related cholecystitis without systemic manifestation is extremely rare. We report a rare case of IgG4-related disease with its clinical, radiological and histopathological findings involving only the gallbladder which presented initially as unresectable locally advanced gallbladder cancer on imaging but was diagnosed as IgG4-related cholecystitis preoperatively depending upon serum IgG4 levels and immunohistochemistry. Patient was successfully treated with steroids followed by simple cholecystectomy in view of symptomatic gallstones. Preoperative diagnosis is challenging for IgG4-related cholecystitis in view of mass like appearance of the lesion with surrounding invasion on imaging so most of the cases are reported postoperatively. Knowledge of this disease as differential for malignancy can save patients from extensive resections in view of its steroid responsive nature. Xanthogranulomatous cholecystitis mimicking gallbladder cancer can coexist with this disease.
免疫球蛋白 G4（IgG4）相关疾病是一种多器官免疫介导的疾病，可模仿许多炎症、恶性和感染性疾病。孤立性 IgG4 相关胆囊炎而无全身表现极为罕见。我们报告了一例罕见的 IgG4 相关疾病病例，其临床表现、影像学和组织病理学表现仅累及胆囊，最初影像学表现为不可切除的局部晚期胆囊癌，但术前根据血清 IgG4 水平和免疫组化检查诊断为 IgG4 相关胆囊炎。由于存在症状性胆囊结石，患者接受类固醇治疗后成功进行了单纯胆囊切除术。由于病变的块状外观和周围侵袭，术前诊断 IgG4 相关胆囊炎具有挑战性，因此大多数病例是在术后报告的。鉴于这种疾病具有类固醇反应性，了解其作为恶性肿瘤的鉴别诊断可以避免患者进行广泛的切除术。黄色肉芽肿性胆囊炎可与这种疾病共存，类似于胆囊癌。
