DOI QR코드

DOI QR Code

A Case of IgG4-Related Pancreas and Kidney Disease Mimicking a Renal Pelvic Malignancy

신우 종괴 형성과 췌장 침범을 동반한 IgG4 연관 경화성 질환 1예

  • Kim, Woo Jae (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Noh, Myung Hwan (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Ryu, Choong Heon (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Han, Seung Hee (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Nam, Hwa Seong (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Han, Ji Eun (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Hong, Sook Hee (Department of Pathology, Dong-A University College of Medicine)
  • 김우재 (동아대학교 의과대학 내과학교실) ;
  • 노명환 (동아대학교 의과대학 내과학교실) ;
  • 류충헌 (동아대학교 의과대학 내과학교실) ;
  • 한승희 (동아대학교 의과대학 내과학교실) ;
  • 남화성 (동아대학교 의과대학 내과학교실) ;
  • 한지은 (동아대학교 의과대학 내과학교실) ;
  • 홍숙희 (동아대학교 의과대학 병리학교실)
  • Received : 2014.06.25
  • Accepted : 2014.07.31
  • Published : 2014.12.01

Abstract

IgG4-related sclerosing disease is a disease entity that has recently attracted attention, manifesting as a multiorgan disease characterized by high serum IgG4 levels, extensive IgG4-positive plasma cells and lymphocyte infiltration of the affected organs, with the pancreas (autoimmune pancreatitis) and kidney as representative targets. In cases of renal involvement, parenchymal lesions are predominant, such as renal cortical lesions or diffuse renal enlargement. However, mass-like lesions involving the renal pelvis are very rare, and mass forming or pelvic involvement types should be distinguished from lymphomas, metastatic cancers and other genitourinary malignancies to avoid unnecessary surgery. Herein, we report a case of IgG4-related sclerosing disease involving the kidney as an unusual involvement pattern presenting as a mass-like lesion with pelvic and perirenal involvement.

Keywords

References

  1. Kamisawa T, Funata N, Hayashi Y, et al. A new clinicopathological entity of IgG4-related autoimmune disease. J Gastroenterol 2003;38:982-984. https://doi.org/10.1007/s00535-003-1175-y
  2. Khalili K, Doyle DJ, Chawla TP, Hanbidge AE. Renal cortical lesions in patients with autoimmune pancreatitis: a clue to differentiation from pancreatic malignancy. Eur J Radiol 2008;67:329-335. https://doi.org/10.1016/j.ejrad.2007.07.020
  3. Takahashi N, Kawashima A, Fletcher JG, Chari ST. Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology 2007;242:791-801. https://doi.org/10.1148/radiol.2423060003
  4. Vlachou PA, Khalili K, Jang HJ, Fischer S, Hirschfield GM, Kim TK. IgG4-related sclerosing disease: autoimmune pancreatitis and extrapancreatic manifestations. RadioGraphics 2011;31:1379-1402. https://doi.org/10.1148/rg.315105735
  5. Park SJ, Kim MH, Moon SH, et al. Clinical characteristics, recurrence features, and treatment outcomes of 55 patients with autoimmune pancreatitis. Korean J Gastroenterol 2008;52:230-246.
  6. Lee YH, Tae HJ, Kim JO, et al. Autoimmune pancreatitis accompanied by tubulointerstitial nephritis. Korean J Med 2012;83:775-780. https://doi.org/10.3904/kjm.2012.83.6.775
  7. Nishino T, Oyama H, Hashimoto E, et al. Clinicopathological differentiation between sclerosing cholangitis with autoimmune pancreatitis and primary sclerosing cholangitis. J Gastroenterol 2007;42:550-559. https://doi.org/10.1007/s00535-007-2038-8
  8. Kawano M, Saeki T, Nakashima H, et al. Proposal for diagnostic criteria for IgG4-related kidney disease. Clin Exp Nephrol 2011;15:615-626. https://doi.org/10.1007/s10157-011-0521-2
  9. Okazaki K, Uchida K, Koyabu M, Miyoshi H, Takaoka M. Recent advances in the concept and diagnosis of autoimmune pancreatitis and IgG4-related disease. J Gastroenterol 2011;46:277-288. https://doi.org/10.1007/s00535-011-0386-x
  10. Kamisawa T, Okazaki K, Kawa S, Shimosegawa T, Tanaka M; Research Committee for Intractable Pancreatic Disease and Japan Pancreas Society. Japanese consensus guidelines for management of autoimmune pancreatitis: III. Treatment and prognosis of AIP. J Gastroenterol 2010;45:471-477. https://doi.org/10.1007/s00535-010-0221-9