Department of Gastroenterology, HangZhou Xixi Hospital, 2 Hengbu Street, Xihu District, HangZhou, 310032, China.
BMC Gastroenterol. 2021 Nov 24;21(1):442. doi: 10.1186/s12876-021-02013-y.
IgG4-related disease mainly manifests as organomegaly and is accompanied by tissue fibrosis (Mimori, Mod Rheumatol 29(2):213, 2019) which is frequently confused with tumour (Dawei et al., J Gastroenterol Hepatol 29(12):1375-8, 2020). There are few reports with of IgG4-related disease with the first clinical manifestation involving the stomach.
We present the case of 46-year-old male patient with a "stomach tumour" as the first manifestation of IgG4-related disease. Gastroscopy showed a mass in the stomach, however, the pathology result was chronic inflammation with IgG4 positivity. CT scans of abdomen showed that the stomach wall was thick, the head of the pancreas was swollen, and retroperitoneal fibrosis was severe.The serum IgG4 level was 75 g/L (normal range 0.03-2.01 g/L).After treatment with methylprednisolone for one month, the symptoms were greatly relieved.
To reduce the suffering of patients and relieve their financial burden, we should consider the possibility of IgG4-related disease when the initial manifestation is a stomach mass.
IgG4 相关疾病主要表现为器官肿大，并伴有组织纤维化（Mimori，Mod Rheumatol 29(2):213, 2019），常与肿瘤混淆（Dawei 等人，J Gastroenterol Hepatol 29(12):1375-8, 2020）。以胃部为首发表现的 IgG4 相关疾病的报道较少。
我们报告了一例 46 岁男性患者，以“胃部肿瘤”为 IgG4 相关疾病的首发表现。胃镜检查显示胃内有肿块，但病理结果显示为慢性炎症伴 IgG4 阳性。腹部 CT 扫描显示胃壁增厚，胰头部肿胀，腹膜后纤维化严重。血清 IgG4 水平为 75g/L（正常值 0.03-2.01g/L）。甲基强的松龙治疗一个月后，症状明显缓解。
为了减轻患者的痛苦和经济负担，当首发表现为胃部肿块时，应考虑 IgG4 相关疾病的可能性。
