Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Immunoglobulin G4-Related Sclerosing Disease Manifesting as Bilateral Tonsillar Hypertrophy on MR Images: A Case Report

  • Park, Mee Hyun (Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital) ;
  • Woo, Ji Young (Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital) ;
  • Lee, Yul (Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital) ;
  • Yoon, Dae Young (Department of Radiology, Hallym University College of Medicine, Kangdong Sacred Heart Hospital) ;
  • Hong, Hye Sook (Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital) ;
  • Hong, Min Eui (Department of Pathology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital)
  • Received : 2015.09.02
  • Accepted : 2015.10.14
  • Published : 2016.02.01
⟨ Previous Next ⟩

Abstract

Immunoglobulin G4-related sclerosing disease (IgG4-SD) is currently recognized as a distinct systemic disease involving various organs. We reported the imaging findings of a case of pathologically confirmed IgG4-SD involving bilateral palatine tonsils. CT and MRI showed diffuse enlargement of both palatine tonsils with homogeneous contrast enhancement. Focal contour bulging was noted in the right palatine tonsil. Lesions appeared as isointense on T1-weighted and slightly hyperintense on T2-weighted MRI images, as compared with muscle. The T2-weighted MRI image showed a striated pattern in both tonsils. Despite its rare occurrence, IgG4-SD should be included in the differential diagnoses of patients with symptomatic bilateral tonsillar hypertrophy that is non-responsive to medication.

Keywords

References

  1. Kamisawa T, Funata N, Hayashi Y, Eishi Y, Koike M, Tsuruta K, 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. Katsura M, Mori H, Kunimatsu A, Sasaki H, Abe O, Machida T, et al. Radiological features of IgG4-related disease in the head, neck, and brain. Neuroradiology 2012;54:873-882 https://doi.org/10.1007/s00234-012-1012-1
  3. Khurram SA, Fernando M, Smith AT, Hunter KD. IgG4-related sclerosing disease clinically mimicking oral squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:e48-e51 https://doi.org/10.1016/j.oooo.2012.04.011
  4. 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;344:732-738 https://doi.org/10.1056/NEJM200103083441005
  5. Kamisawa T, Okamoto A. IgG4-related sclerosing disease. World J Gastroenterol 2008;14:3948-3955 https://doi.org/10.3748/wjg.14.3948
  6. 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
  7. 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
  8. Ko Y, Woo JY, Kim JW, Hong HS, Yang I, Lee Y, et al. An immunoglobulin G4-related sclerosing disease of the small bowel: CT and small bowel series findings. Korean J Radiol 2013;14:776-780 https://doi.org/10.3348/kjr.2013.14.5.776
  9. Coulier B, Montfort L, Beniuga G, Pierard F, Gielen I. Small bowel obstruction caused by peritoneal immunoglobulin g4-related disease mimicking carcinomatosis: case report. Korean J Radiol 2014;15:66-71 https://doi.org/10.3348/kjr.2014.15.1.66
  10. Choi JW, Kim SY, Moon KC, Cho JY, Kim SH. Immunoglobulin G4-related sclerosing disease involving the urethra: case report. Korean J Radiol 2012;13:803-807 https://doi.org/10.3348/kjr.2012.13.6.803
  11. Rossi M, Virgilio E, Laurino F, Orgera G, Mene P, Pirozzi N, et al. Giant hepatic artery aneurysm associated with immunoglobulin G4-related disease successfully treated using a liquid embolic agent. Korean J Radiol 2015;16:953-954 https://doi.org/10.3348/kjr.2015.16.4.953