IgG4-related disease manifesting as an acute gastric-pericardial fistula

Frydman, James; Grunner, Shahar; Kluger, Yoram

doi:10.3748/wjg.v20.i44.16782

Cited by 13 publications

(5 citation statements)

References 20 publications

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“…IgG4‐related gastrointestinal (GI) disease (IgG4‐GID) is rare, but it has been reported anecdotally. In fact, various clinical manifestations, such as ulcerations, 1–5 polyps, 6–8 wall thickening, 9–16 submucosal tumors (SMTs), 17–27 GI obstruction, 28–30 vasculitis, 31 fistulas, 32,33 and the infiltration of IgG4‐positive plasma cells without morphologic abnormalities, 34 have been reported in IgG4‐GID. As a matter of fact, most cases of IgG4‐GID do not exhibit other organ involvement as observed in IgG4‐RD cases; thus, it is unlikely that all these cases represent genuine IgG4‐GID.…”

Section: Introductionmentioning

confidence: 99%

Utility of gastric biopsy in diagnosing IgG4‐related gastrointestinal disease

Uchino

Notohara

Uehara

et al. 2020

Pathology International

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The utility of gastric biopsy for diagnosing immunoglobulin (Ig)G4‐related gastrointestinal disease (IgG4‐GID) remains unclear. Bottom‐heavy plasmacytosis (BHP) is a distinct feature of IgG4‐GID. To clarify the feasibility of using gastric biopsies to diagnose BHP in IgG4‐GID, we analyzed the histological features and immunostaining of gastric biopsy specimens from 31 known IgG4‐related disease (IgG4‐RD) patients and we assessed the presence of BHP in 1696 consecutive routine gastric biopsies. Cases with both >10 IgG4‐positive plasma cells per high‐power field and an IgG4/IgG‐positive ratio >40% were defined as IgG4‐high. Ten of the 31 IgG4‐RD patients were concluded to have IgG4‐GID, in which IgG4‐positive plasma cells were notably detected at the deeper part of the mucosa. Six cases displayed BHP whereas the remaining four cases showed transmural infiltration with concomitant Helicobacter pylori‐associated gastritis. In addition to BHP, we identified two unique histologic features for IgG4‐GID: plasmacytic aggregation in the muscularis mucosae and permeative plasmacytic infiltration between fundic glands in the non‐atrophic mucosa. Six of the routine cases (0.35%) displayed BHP, including a case with IgG4‐RD. IgG4‐GID can be suspected by the presence of gastric biopsy specimens with characteristic histological features. Such cases are recommended to undergo further examinations to determine whether IgG4‐RD is present.

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Section: Introductionmentioning

confidence: 99%

Utility of gastric biopsy in diagnosing IgG4‐related gastrointestinal disease

Uchino

Notohara

Uehara

et al. 2020

Pathology International

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“…Table 2 presents the baseline demographics, diagnostic findings, and chief clinical features of gastric IgG4‐RD from the individual cases ( n = 42) 7–12,17–47 . There were slightly more male cases than female cases (59.5% male).…”

Section: Resultsmentioning

confidence: 99%

Clinicopathological characteristics of gastric IgG4‐related disease: Systematic scoping review

Sawada

Czech

Silangcruz

et al. 2022

J of Gastro and Hepatol

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Background and Aim: Gastric IgG4-related disease (IgG4-RD) can mimic malignancy, submucosal tumors (SMT), and ulcers, leading to over-triage and unnecessary medical interventions such as gastrectomy. The variability in the clinicopathological presentation of IgG4-related disease is not yet well defined, posing a diagnostic challenge. Methods: Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "gastritis," "stomach," "gastrointestinal stromal tumor," and "IgG4-RD" from their inception to December 28, 2021. Results: Thirty-nine articles, including 2 observational studies and 42 cases, were included in the systematic review. While bottom-heavy lymphoplasmacytic mucosal infiltration is a characteristic finding of gastric IgG4-RD, it was only present in less than half of the patients in the observational studies. Patients with gastric IgG4-RD were more likely to be diagnosed with gastrointestinal stromal tumor (GIST), gastric cancer, or peptic ulcer disease and their clinical course involved resection (51.3%) or even gastrectomy. Diagnosis of gastric IgG4-RD was most frequently made by post-operative pathological analysis. Conclusion: This systematic review summarizes the current understanding of the characteristics of gastric IgG4-RD. Increased awareness of gastric IgG4-RD as a differential diagnosis of gastric SMT or ulcers among clinicians is crucial in order to reduce unnecessary high-risk, invasive interventions.

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“…IgG4-related gastric ulcers are very uncommon and by the time these diffuse gastric ulcers make scars, fistula [42], fibrosis, and stricture of the gastric lumen [27,43]. Gastric involvement [22] of IgG4+ ulcers can be found significantly more frequently in patients with AIP [44].…”

Section: Igg4-related Gastric Ulcerative Lesionsmentioning

confidence: 99%

“…In addition, 2 patients, one with intractable gastric ulcer that was suspicious for malignant features after antacids regimen failed to improve the ulcer [43] and another with giant gastric ulceration [12], both lesions showed fibrosis, storiform pattern, and significant counts of IgG4+ plasmacytes. Frydman et al [42] report-ed a patient with acute gastric-pericardial fistula secondary to an IgG4-related chronic necrotic gastric ulcer. A pathological specimen of complete gastrectomy showed extensive fibrosis with abundant infiltration of IgG4+ plasmacytes.…”

Section: Igg4-related Gastric Ulcerative Lesionsmentioning

confidence: 99%

Immunoglobulin G4-Related Disease Manifesting as Isolated, Typical, and Nontypical Gastroesophageal Lesion: A Research of Literature Review

et al. 2019

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Background: Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune inflammatory and fibrotic condition. The disease is characterized by tissue infiltration with dense lymphoplasmacytes and IgG4-positive plasma cells. Summary: The aim of this study was to provide gastroenterologists with novel insights into evaluating the gastroesophageal involvement with IgG4-RD or mimickers of this condition and to give special attention to clinicopathological features. A literature review was performed using the PubMed database. A total of 39 studies presenting cases in the form of isolated, typical, and nontypical gastroesophageal involvement with IgG4-RD published between 2010 and 2018 were included. These studies were thoroughly reviewed for symptoms, lesion location, lesion type, lesion size, immune-histopathology, associated diseases, treatment, and follow-up. Of the 39 studies reviewed, 9 were esophageal IgG4-RD lesions, isolated esophageal IgG4-RD 66.66% (6/9), a typical form of esophageal IgG4-RD 11.11% (1/9), and nontypical form esophageal IgG4-RD 22.22% (2/9). The 30 gastric IgG4-RD that include isolated gastric IgG4-RD 46.66% (14/30), typical gastric IgG4-RD 40% (12/30), and nontypical gastric IgG4-RD 13.33% (4/30). The majority of lesions were inflammatory tumors, ulceration, nodular lesions, chronic gastritis, and malignant lesions. Key Messages: IgG4-RD may be manifested by isolated, typical and nontypical forms of gastroesophageal lesions and should be taken into consideration in the differential diagnosis. Corticosteroids may be the sole diagnostic treatment for this condition.

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IgG4-related disease manifesting as an acute gastric-pericardial fistula

Cited by 13 publications

References 20 publications

Utility of gastric biopsy in diagnosing IgG4‐related gastrointestinal disease

Utility of gastric biopsy in diagnosing IgG4‐related gastrointestinal disease

Clinicopathological characteristics of gastric IgG4‐related disease: Systematic scoping review

Immunoglobulin G4-Related Disease Manifesting as Isolated, Typical, and Nontypical Gastroesophageal Lesion: A Research of Literature Review

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