Koiwai Akinobu, Hirota Morihisa, Satoh Mari, Takasu Atsuko, Meguro Takayoshi, Endo Katsuya, Kogure Takayuki, Murakami Keigo, Murakami Kazuhiro, Satoh Kennichi
Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Division of Pathology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Case Rep Gastroenterol. 2021 Jun 10;15(2):488-494. doi: 10.1159/000516687. eCollection 2021 May-Aug.
A 71-year-old man with obstructive jaundice was referred to our department. He underwent cholangiojejunostomy 15 years ago for palliative drainage. At that time, he had obstructive jaundice caused by an unresectable pancreatic head tumor. Contrast-enhanced computed tomography (CE-CT) now revealed a mass with low enhancement in the hepatic hilum that occluded the hilar bile duct and infiltrated extensively along the portal vein and hepatic artery. CE-CT also showed marked atrophy of the left hepatic lobe. No swelling or tumors were observed in the pancreas. Serum immunoglobulin G4 (IgG4) levels were as high as 465 mg/dL. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) was performed targeting the hepatic hilar lesion. Immunohistological results of the biopsy specimens suggested that the lesion was an IgG4-related hepatic inflammatory pseudotumor (IPT) with no atypical cells. Steroid treatment resulted in rapid clinical improvement. This case suggested the usefulness of EUS-FNB for diagnosing IgG4-related hepatic hilar IPT.
一名71岁患有梗阻性黄疸的男性被转诊至我科。15年前，他因姑息性引流接受了胆管空肠吻合术。当时，他患有由不可切除的胰头肿瘤引起的梗阻性黄疸。目前，增强计算机断层扫描（CE-CT）显示肝门处有一个强化程度低的肿块，该肿块阻塞了肝门胆管，并沿门静脉和肝动脉广泛浸润。CE-CT还显示左肝叶明显萎缩。胰腺未观察到肿大或肿瘤。血清免疫球蛋白G4（IgG4）水平高达465mg/dL。针对肝门病变进行了内镜超声引导下细针穿刺活检（EUS-FNB）。活检标本的免疫组织学结果提示该病变为IgG4相关性肝炎性假瘤（IPT），无非典型细胞。类固醇治疗使临床症状迅速改善。该病例提示EUS-FNB对诊断IgG4相关性肝门IPT有用。
