Skip to main content

Advertisement

SpringerLink
Log in

An immunoglobulin G4-related disease mimicking postoperative lung cancer recurrence

  • Case Report
  • Published:
Modern Rheumatology

Abstract

A postoperative lung cancer patient presented with lymphadenopathy, pleural thickening, and 18F-fluorodeoxyglucose (FDG) uptake on a positron emission tomography–computed tomography (PET–CT) scan. Lung cancer recurrence was initially suspected, but bilateral submandibular masses with 18F-FDG uptake indicated the possibility of a systemic disease, such as Mikulicz’s disease. High serum immunoglobulin G4 (IgG4) and IgG4-positive plasma cell infiltration in the submandibular glands led to the diagnosis of IgG4-related disease. After systemic steroid therapy, 18F-FDG uptake decreased in both the submandibular glands and the suspected recurrent lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344:732–8.

    Article  PubMed  CAS  Google Scholar 

  2. Kamisawa T, Okamoto A. IgG4-related sclerosing disease. World J Gastroenterol. 2008;14:3948–55.

    Article  PubMed  CAS  Google Scholar 

  3. Masaki Y, Kurose N, Umehara H. IgG4-related disease: a novel lymphoproliferative disorder discovered and established in Japan in the 21st century. J Clin Exp Hematop. 2011;51:13–20.

    Article  PubMed  Google Scholar 

  4. Masaki Y, Sugai S, Umehara H. IgG4-related diseases including Mikulicz’s disease and sclerosing pancreatitis: diagnostic insights. J Rheumatol. 2010;37:1380–5.

    Article  PubMed  CAS  Google Scholar 

  5. Zen Y, Inoue D, Kitao A, Onodera M, Abo H, Miyayama S, et al. IgG4-related lung and pleural disease: a clinicopathologic study of 21 cases. Am J Surg Pathol. 2009;33:1886–93.

    Article  PubMed  Google Scholar 

  6. Martin J, Ginsberg RJ, Venkatraman ES, Bains MS, Downey RJ, Korst RJ, et al. Long-term results of combined-modality therapy in resectable non-small-cell lung cancer. J Clin Oncol. 2002;20:1989–95.

    Article  PubMed  Google Scholar 

  7. Takenaka D, Ohno Y, Koyama H, Nogami M, Onishi Y, Matsumoto K, et al. Integrated FDG-PET/CT vs. standard radiological examinations: comparison of capability for assessment of postoperative recurrence in non-small cell lung cancer patients. Eur J Radiol. 2010;74:458–64.

    Article  PubMed  Google Scholar 

  8. Kanzaki R, Higashiyama M, Maeda J, Okami J, Hosoki T, Hasegawa Y, et al. Clinical value of F18-fluorodeoxyglucose positron emission tomography–computed tomography in patients with non-small cell lung cancer after potentially curative surgery: experience with 241 patients. Interact Cardiovasc Thorac Surg. 2010;10:1009–14.

    Article  PubMed  Google Scholar 

  9. Chan JK, Kwong YL. Common misdiagnoses in lymphomas and avoidance strategies. Lancet Oncol. 2010;11:579–88.

    Article  PubMed  Google Scholar 

  10. Inoue D, Zen Y, Abo H, Gabata T, Demachi H, Kobayashi T, et al. Immunoglobulin G4-related lung disease: CT findings with pathologic correlations. Radiology. 2009;251:260–70.

    Article  PubMed  Google Scholar 

  11. Kamisawa T, Chen PY, Tu Y, Nakajima H, Egawa N, Tsuruta K, et al. Pancreatic cancer with a high serum IgG4 concentration. World J Gastroenterol. 2006;12:6225–8.

    PubMed  CAS  Google Scholar 

  12. Cheuk W, Yuen HK, Chan AC, Shih LY, Kuo TT, Ma MW, et al. Ocular adnexal lymphoma associated with IgG4+ chronic sclerosing dacryoadenitis: a previously undescribed complication of IgG4-related sclerosing disease. Am J Surg Pathol. 2008;32:1159–67.

    Article  PubMed  Google Scholar 

  13. Ikari J, Kojima M, Tomita K, Nakamura T, Toyoda F, Otsuki Y, et al. A case of IgG4-related lung disease associated with multicentric Castleman’s disease and lung cancer. Intern Med. 2010;49:1287–91.

    Article  PubMed  Google Scholar 

  14. Miyake K, Moriyama M, Aizawa K, Nagano S, Inoue Y, Sadanaga A, et al. Peripheral CD4+ T cells showing a Th2 phenotype in a patient with Mikulicz’s disease associated with lymphadenopathy and pleural effusion. Mod Rheumatol. 2008;18:86–90.

    Article  PubMed  Google Scholar 

  15. Nakajo M, Jinnouchi S, Fukukura Y, Tanabe H, Tateno R, Nakajo M. The efficacy of whole-body FDG-PET or PET/CT for autoimmune pancreatitis and associated extrapancreatic autoimmune lesions. Eur J Nucl Med Mol Imaging. 2007;34:2088–95.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Seshiru Nakazawa, Kimihiro Shimizu, Tetsuhiro Nakano, Seiichi Kakegawa, Jun Atsumi, Mitsuhiro Kamiyoshihara & Izumi Takeyoshi

  2. Department of Pathology, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Junko Hirato

Authors
  1. Seshiru Nakazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimihiro Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsuhiro Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seiichi Kakegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Atsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mitsuhiro Kamiyoshihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Junko Hirato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Izumi Takeyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimihiro Shimizu.

About this article

Cite this article

Nakazawa, S., Shimizu, K., Nakano, T. et al. An immunoglobulin G4-related disease mimicking postoperative lung cancer recurrence. Mod Rheumatol 22, 787–790 (2012). https://doi.org/10.1007/s10165-011-0580-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10165-011-0580-y

Keywords

Search

Navigation