Abstract
BackgroundImmunoglobulin G4-related disease is characterized by infiltration of immunoglobulin G4-positive plasmacytes in various organs. The radiological findings of lung involvement of immunoglobulin G4-related disease include hilar and mediastinal lymphadenopathies, thickness of bronchovascular bundles, peribronchovascular consolidation, and lung nodules. Although a pathological approach is needed to diagnose immunoglobulin G4-related disease, it is ordinarily diagnosed by biopsy from one lesion even if there are multiple lesions. We reported a rare case of the coexistence of immunoglobulin G4-related disease and lung cancer in the same lung nodule.Case presentationA 72-year-old Japanese man visited our hospital for evaluation of a nodular shadow in the middle lobe of his right lung that was seen on chest radiograph and computed tomography scan. An abdominal computed tomography scan showed a tumefactive lesion in his anterior sacral spine. Blood examinations revealed high serum immunoglobulin G4 concentration at 346 mg/dl, renal dysfunction, and anemia. He underwent right upper lobectomy and regional lymph node dissection. Pathologic findings of the lung nodule showed lepidic pattern adenocarcinoma with infiltration of immunoglobulin G4-positive plasma cells and obliterative phlebitis.ConclusionsTo date, there have been only few reports on the coexistence of immunoglobulin G4-related disease and lung cancer; here, we report such a rare case. Histologic examination should be considered in cases of suspicious immunoglobulin G4-related disease appearing in a lung nodule.
Highlights
Immunoglobulin G4-related disease is characterized by infiltration of immunoglobulin G4-positive plasmacytes in various organs
Histologic examination should be considered in cases of suspicious immunoglobulin G4-related disease appearing in a lung nodule
A transbronchial biopsy with bronchoscopy was performed, which revealed carcinoma cells on cytology. He was diagnosed with lung cancer at T1bN0M0, stage 1A; this was suspected to be related to IgG4-related retroperitoneal fibrosis
Summary
We reported a rare case of lung cancer coexisting with IgG4-related disease in the same lung nodule. Pathologic correlation by bronchoscopy and/or surgery should be considered in cases of suspicious IgG4-related disease appearing in a lung nodule. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions HT was responsible for data collection, analysis, and interpretation, and drafting the manuscript. KT drafted and critically revised the manuscript. KK, SK, and NSA reviewed the manuscript, and helped to draft the manuscript. All authors read and approved the final manuscript
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