54-Year-Old Man With Severe Prostatism, Palatal Mass, and History of Pancreatitis

Abstract

54-year-old man with a history of benign prostatic hypertrophy, hypothyroidism, and well-controlled insulin-dependent diabetes mellitus secondary to idiopathic pancreatitis presented to our internal medicine consultation clinic. He complained of a lump in the hard palate, dry mouth present for 2 years, and bilateral submandibular gland swelling for which he had been evaluated by an otolaryngologist. A previous biopsy of the hard palate mass had demonstrated florid reactive lymphoid hyperplasia with fibrosis, polyclonal plasmacytosis and increased IgG4-positive plasma cells. He also complained of obstructive urinary symptoms and was found to have a very large and nodular prostate on digital rectal examination. The prostate-specific antigen level was 0.13 ng/mL (reference range, 0-3.2 ng/ mL), and results of urinalysis were unremarkable. A computed tomographic scan of the chest from an outside facility showed a mass in the right middle lobe in addition to bilateral renal lesions. Suspicion for a common link among his current symptoms and previous diagnoses was raised. 1. Which of the following is the most likely unifying diagnosis? a. Multiple myeloma b. Amyloidosis c. Metastatic prostate cancer d. IgG4-related sclerosing disease (IgG4RSD)