自己免疫性膵炎の合併が示唆されたIgG4 関連慢性硬化性顎下腺炎の1例

Abstract

We report a case of IgG4-related chronic sclerosing sialadenitis （CSS） of the submandiblar gland. A 68-year-old man was found to have left submandibular swelling during postoperative follow-up for tongue cancer. We examined the fine needle aspiration （FNA）, MRI, CT and cervical ultrasonographic findings, and a diagnosis of submandiblar gland tumor/inflammation was suspected. After making this diagnosis, we dissected the submandiblar triangle, which included the ablated submandiblar gland and lymph nodes. The pathological diagnosis was CSS. Thereafter, histochemical analysis demonstrated that more than 50％ of the infiltrated plasma cells were IgG-antibody positive. In addition, a blood examination showed a high serum IgG4 level. Postoperative PET-CT examinations showed a hot spot in the tail of pancreas, suggesting the presence of IgG4-related autoimmune pancreatitis as a complication. At present, more than 2 years 8 months after diagnosis, there has been no exacerbation of autoimmune pancreatitis or onset of any other systemic IgG4-related sclerosing disease.