Cho Min Ji, Moon Hee Seok, Lee Hyeon Seok, Park Jae Ho, Kim Ju Seok, Kang Sun Hyung, Lee Eaum Seok, Kim Seok Hyun, Sung Jae Kyu, Lee Byung Seok, Jeong Hyun Yong
Division of Gastroenterology, Departmentof Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon , Republic of Korea.
Medicine (Baltimore). 2020 Sep 4;99(36):e22078. doi: 10.1097/MD.0000000000022078.
Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder characterized by specific pathologic findings and often, but not in all cases, elevated serum IgG4 concentration. Although it can virtually involve every organ system, cases involving the gastrointestinal tract and especially gastric mass lesions have rarely been reported.
A 45-year-old man, who was incidentally discovered asymptomatic subepithelial tumor (SET), by endoscopy, on the greater curvature of the upper gastric body, was referred to our hospital for further evaluation.
The patient was postoperatively diagnosed with IgG4-RD by histopathologic results.
The patient underwent laparoscopic wedge resection.
The patient is presently followed up annually in our clinic and had no problems and showed no signs of recurrence in examination.
We reported a rare case of IgG4-RD presenting as a gastric SET. The first line treatment of IgG4-RD is glucocorticoid administration. However, because pathologic examination is challenging owing to the lesion location, preoperative diagnosis is difficult and may lead to unnecessary gastric resection. Thus, using alternative preoperative diagnostic methods such as endoscopic ultrasound-guided fine-needle biopsy or the biopsy unroofing technique could spare the patient from unnecessary surgical treatment.
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，且血清IgG4浓度通常（但并非在所有病例中）升高。尽管它几乎可累及每个器官系统，但涉及胃肠道尤其是胃肿物病变的病例鲜有报道。
一名45岁男性，在内镜检查时偶然发现胃体上部大弯处有无症状的上皮下肿瘤（SET），遂转诊至我院进一步评估。
术后经组织病理学结果诊断该患者患有IgG4-RD。
患者接受了腹腔镜楔形切除术。
目前该患者在我院门诊每年接受随访，未出现问题，检查中也未显示复发迹象。
我们报告了一例罕见的以胃SET形式出现的IgG4-RD病例。IgG4-RD的一线治疗是给予糖皮质激素。然而，由于病变位置导致病理检查具有挑战性，术前诊断困难，可能会导致不必要的胃切除术。因此，使用内镜超声引导下细针穿刺活检或活检揭盖技术等替代术前诊断方法可以避免患者接受不必要的手术治疗。
