Abstract
IgG4-related disease (IgG4-RD) is a systemic autoimmune disorder that has been defined in various organs. The disease is characterized by typical clinicopathological features including a dense lymphoplasmacytic infiltrate rich in IgG4 positive plasma cells, storiform fibrosis, obliterative phlebitis, and often an elevated serum IgG4 level. Esophageal IgG4-RD is rare, and its presentation as a solid mass is even more rare. Only 15 previous cases of IgG4-related esophageal disease have been described. We herein present a case of giant IgG4-related pseudotumor of the esophagus resected with endoscopic submucosal dissection (ESD) and a review of the literature. The patient was a 67-year-old man who was admitted to our hospital for assessment of progressive dysphagia. Upper gastrointestinal endoscopy revealed a 9 cm mass in the cervical esophagus. In the previous two hospitals, the patient's mass could not be diagnosed despite repeated biopsies. Because of concerns regarding malignancy, endoscopic submucosal dissection was performed. Histopathological examination showed dense lymphoplasmacytic infiltration with predominant IgG4-positive plasma cells on a sclerotic background. The patient was diagnosed with IgG4-RD. During the follow-up, no residual mass was detected but the patient was diagnosed with lung adenocarcinoma. We present a unique case of giant IgG4-related pseudotumor of the esophagus. Resection with ESD of such a big mass of IgG4-RD in the esophageal region has never been reported before in the literature.
Highlights
IgG4-related disease (IgG4-RD), originally described in the pancreas by Sarles et al in 1961 [1], is a fascinating clinical entity of unknown etiology characterized by high serum IgG4 concentrations and tumefaction or tissue infiltration by IgG4-positive plasma cells
The disorder is recognized as a systemic disease characterized by specific histopathological findings that include the presence of predominant IgG4-positive plasma cells in a background of intense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis [2]
IgG4-RD is an immune-mediated fibroinflammatory condition that has been described in a variety of organs [11]
Summary
IgG4-related disease (IgG4-RD), originally described in the pancreas by Sarles et al in 1961 [1], is a fascinating clinical entity of unknown etiology characterized by high serum IgG4 concentrations and tumefaction or tissue infiltration by IgG4-positive plasma cells. The disorder is recognized as a systemic disease characterized by specific histopathological findings that include the presence of predominant IgG4-positive plasma cells in a background of intense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis [2]. It has been reported in almost any organ and tissue in the body including the pancreatobiliary system, lacrimal glands, salivary glands, central nervous system, thyroid, lungs, liver, gastrointestinal tract, kidney, prostate, retroperitoneum, arteries, lymph nodes, skin, and breast [3,4,5]. The patient received chemotherapy but 21 months after the ESD procedure, he passed away with unknown cause, and no autopsy was performed
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