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首页> 外文期刊>Zeitschrift fur Gastroenterologie >Immunoglobulin G4 (IgG4)-related disease of the stomach – a?challenging differential diagnosis in suspected gastric cancer
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Immunoglobulin G4 (IgG4)-related disease of the stomach – a?challenging differential diagnosis in suspected gastric cancer

机译：免疫球蛋白G4（IgG4） - 胃的相关疾病 - a？敏感在疑似胃癌中的鉴别诊断

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Background?Immunoglobulin G4-related disease (IgG4-RD) can involve different organs and is diagnosed by a combination of clinicopathological features, including storiform fibrosclerosis infiltrated by numerous IgG4-positive plasma cells that frequently forms tumor-like lesions with or without associated obliterative phlebitis. Involvement of the stomach is rare and can occur as part of a multiorgan involvement of IgG4-RD or as isolated gastric involvement. Case report?We report 2 female patients with therapy-refractory gastric ulcers associated with gastric wall thickening and lymphadenopathy that were highly suggestive of gastric cancer or lymphoma. Biopsies failed to confirm a diagnosis, and IgG4-RD was diagnosed only after surgical resection in both patients. The previous literature on gastric IgG4-RD is summarized and shows different characteristics in patients with multiorgan IgG4-RD and isolated gastric IgG4-RD. As reported for autoimmune pancreatitis type 1, patients with multiorgan IgG4-RD are mainly elderly men with frequently elevated serum IgG4 concentrations. In contrast, isolated gastric IgG4-RD predominantly affects female patients with normal serum IgG4 levels. Surgical resection is commonly performed due to the clinical suspicion of malignancy and the absence of findings indicative of IgG4-RD on biopsy. Today, diagnosis is confirmed histopathologically only after resection. Conclusion?IgG4-RD should be taken into account when gastric malignancy is suspected endoscopically or radiologically and biopsies fail to confirm the presence of a malignancy (especially subepithelial tumors or refractory gastric ulcers). Serum IgG4 concentrations are insufficient to confirm localized gastric IgG4-RD. Diagnostic workups need to be improved to avoid unnecessary surgical resections with the attendant potential morbidity and mortality.
机译：背景技术α相关疾病（IgG4-Rd）可以涉及不同的器官，并且通过临床病理特征的组合诊断，包括由多种IgG4阳性血浆细胞渗透渗透的储层纤维粥样硬化，它们通常会形成有或没有相关的抗野性静脉炎。胃的参与是罕见的，可以作为IgG4-RD的多功能累及的一部分或作为分离的胃部受累发生。案例报告？我们报告2例治疗 - 难治性胃溃疡患者，与胃壁增厚和淋巴结病，胃癌或淋巴瘤高度暗示。活检未能确认诊断，并且仅在两种患者的手术切除后被诊断为IgG4-RD。总结了胃IgG4-RD上以前的文献，并显示了多功能IgG4-Rd和分离的胃IgG4-Rd患者的不同特征。据报道，对于自身免疫性胰腺炎1型，患者IgG4-RD患者主要是具有经常升高的血清IgG4浓度的老年人。相比之下，分离的胃IgG4-RD主要影响患有正常血清IgG4水平的女性患者。由于对恶性肿瘤的临床怀疑以及表明活检的IgG4-Rd的发现，常见的手术切除术。今天，诊断只在切除后组织病理学才能确认。结论？当内窥镜或放射学前怀疑胃恶性肿瘤时，应考虑IgG4-RD，活组织检查未能确认恶性肿瘤（特别是耻骨上皮肿瘤或难治性胃溃疡）。血清IgG4浓度不足以确认局部胃IgG4-RD。需要改善诊断次数，以避免不必要的手术切除与服务员的潜在发病率和死亡率。

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