Abstract
IgG4-related disease is a rare systemic disorder having an underlying autoimmune cause. These disorders mainly affects pancreatico biliary tree, i.e., pancreas, gall bladder, and biliary tree (extrahepatic as well intrahepatic), but can also affect other part of the body. Majority of disorders involving biliary tree are associated with autoimmune pancreatitis component. These disorders are difficult to diagnose clinically as they can mimic inflammatory as well malignancy and poses a real diagnostic challenge to manage and treat. Sixty-four-year-old female known diabetic evaluated for pain in right hypochondrium. Gall bladder cancer was suspected clinically as well on radiological basis. Patient underwent extended cholecystectomy as it was a resectable disease. Final histopathology revealed immunoglobulin G4 (IgG4)-related cholecystitis which was confirmed after immunohistochemistry for CD 138 and IgG4.This disease could be managed conservatively by giving oral steroids, if it has been picked up preoperatively and major surgical intervention have been avoided. No defined blood test or tumor markers are currently available to diagnose this entity except serum immunoglobulin G4 which is costly and not feasible to get done in all patients especially in developing nations like India. IgG4 cholecystitis is an immune-mediated disease whose pathophysiology is still not completely understood. Every clinician should keep possibility of IgG4 cholecystitis in mind whenever any patient with abnormal gall bladder thickening or gall bladder mass is encountered in their clinical practice, as both these entities have completely different options of treatment. We should not rely solely upon clinical and radiological picture.
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Abbreviations
- IgG4 :
-
Immunoglobulin G4
- IgG4-RD :
-
Immunoglobulin G4-related disorder
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RS—drafted the case manuscript and was the main operating surgeon. PM—part of surgical team and helped in drafting the manuscript. RP, VR, JS, CK—all were part of surgical team and helped in citing references for the case report. JG—helped in framing discussion part. KM—reported the final histopathology report. All authors read and approved the final manuscript.
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Singh, R., Mahajan, P., Prasher, R. et al. Immunoglobulin (IgG4) Sclerosing Cholecystitis-Camouflaging Gall Bladder Cancer—a Case Report and Review of Literature. SN Compr. Clin. Med. 5, 43 (2023). https://doi.org/10.1007/s42399-022-01371-2
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DOI: https://doi.org/10.1007/s42399-022-01371-2