IgG4-related disease presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery: a case report

• Published in: Surgical case reports 2020-05, Vol.6 (1), p.93-93, Article 93
• Main Authors: Yamane, Taishi, Eto, Kojiro, Morinaga, Takeshi, Matsumura, Kazuki, Yamashita, Kohei, Tokunaga, Ryuma, Harada, Kazuto, Hiyoshi, Yukiharu, Nagai, Yohei, Iwatsuki, Masaki, Iwagami, Shiro, Miyamoto, Yuji, Yoshida, Naoya, Baba, Hideo
• Format: Article
• Language: English
• Subjects: Case Report; Case reports; Endoscopy; IgG4-related disease (IgG4-RD); Laparoscopic endoscopic cooperative surgery (LECS); Laparoscopy; Medicine; Medicine & Public Health; Stomach; Submucosal tumor of the stomach; Surgery
• ISSN: 2198-7793; 2198-7793
• DOI: 10.1186/s40792-020-00851-8

Background IgG4-related disease (IgG4-RD) is an immune-mediated disorder in which abundant IgG4-positive plasma cells infiltrate affected organs. There have been reported four cases of probable IgG4-RD presenting as a submucosal tumor of the stomach. We herein report the first case of definite IgG4-RD presenting as a submucosal tumor of the stomach resected with laparoscopic endoscopic cooperative surgery (LECS). Case presentation A 70-year-old woman with a 6-year history of autoimmune pancreatitis was referred to our department because a 15-mm submucosal tumor in the greater curvature of the lower part of the stomach had been identified via upper gastrointestinal endoscopy. Endoscopic ultrasonography showed a 10-mm low-echoic lesion derived from the submucosal layer of the stomach. A fine-needle aspiration biopsy was attempted, but the tumor was too hard for sampling. F-fluorodeoxyglucose (FDG) positron emission tomography showed an FDG uptake, suggesting a possibility of malignant disease. As the diagnosis could not be confirmed, LECS for both the diagnosis and curative treatment was performed. A histopathological examination showed a tumor with IgG4-positive lymphoplasmacytic infiltration and fibrosis. The ratio of IgG4+/IgG+ lymphoplasmacytic cells was > 80%. A laboratory examination showed elevation of the serum IgG4 levels preoperatively. Thus, the final diagnosis was IgG4-RD of the stomach. No recurrence was observed within 1 year after surgery. Conclusions We encountered a case of definite IgG4-RD presenting as a gastric SMT in which a correct diagnosis was achieved by a minimally invasive LECS technique. IgG4-RD may present as a gastric lesion and should be taken into consideration as a differential diagnosis.