AccScience Publishing / TD / Volume 2 / Issue 3 / DOI: 10.36922/td.1766
Submit to TD
Cite this article
39
Download
703
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
CASE REPORT

A rare clinical observation of ureteral IgG4-related disease in urological practice: A case report

Ekaterina Anikanova1,2* ,  Daniel Yagudaev1,3 ,  Konstantin Firsov1,3 ,  Nina Kalyagina4,5* ,  Arina Plotnikova5
Show Less
1 Department of Urology and Oncology, Central Clinical Hospital “Russian Railways-Medicine,” Moscow, Russia
2 Department of Oncology and Radiology, Medical Faculty, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
3 Department of Endoscopic Urology, Faculty of Further Education, the Peoples’ Friendship University of Russia, Moscow, Russia
4 Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
5 Engineering Physics Institute of Biomedicine, National Research Nuclear University MEPhI, Moscow, Russia
Tumor Discovery 2023, 2(3), 1766 https://doi.org/10.36922/td.1766
Submitted: 5 September 2023 | Accepted: 13 November 2023 | Published: 24 November 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
Abstract

IgG4-related disease (IgG4-RD) is a systemic immune-dependent pathology marked by infiltration of lymphocytes and plasma cells expressing IgG4 in affected tissues, leading to phlebitis and fibrosclerosis. In urological practice, diagnosing IgG4-RD of the ureter, which may resemble a malignant tumor, presents challenges. We present a unique case: a 64-year-old patient (Patient P.) experienced left lumbar discomfort and a 4 kg weight loss over 2 months. A computed tomography scan revealed a 111 mm tumor obstructing the left ureter, causing hydronephrosis and regional lymphadenopathy. Suspecting ureteral urothelial cancer, the patient underwent a left nephroureterectomy with lymphadenectomy. Microscopic analysis revealed fibrosis and inflammation infiltration (lymphocytes, plasma cells, and eosinophils) in the ureter wall, with no evidence of tumor growth. Immunohistochemistry confirmed IgG4-positive plasma cells. Serum IgG4 rose to 149 mg/dL. Morphological findings led to a diagnosis of IgG4-RD of the ureter. Clinically, it is crucial to recognize IgG4-RD in ureteral neoplasms for early detection, to prevent unnecessary surgical intervention.

Keywords
IgG4-related diseases
IgG4
Ureter
Pseudotumor inflammation
Urothelial cancer
Funding
Ministry of Higher Education and Science of the Russian Federation
References
  1. Maritati F, Peyronel F, Vaglio A, 2020, IgG4-related disease: A clinical perspective. Rheumatology (Oxford), 59(Suppl 3): iii123–iii131. https://doi.org/10.1093/rheumatology/kez667

 

  1. Zhang W, Stone JH, 2019, Management of IgG4-related disease. Lancet Rheumatol, 1: e55–e65. https://doi.org/10.1016/S2665-9913(19)30017-7

 

  1. Zykova A, Novikov P, Brovko M, et al., 2020, IgG4-related disease: The state of art. Clin Pharmacol Ther, 29(3): 4–13. (In Russ). https://doi.org/10.32756/0869-5490-2020-3-4-13

 

  1. Kamisawa T, Funata N, Hayashi Y, et al., 2003, A new clinicopathological entity of IgG4-related autoimmune disease. J Gastroenterol, 38(10): 982–984. https://doi.org/10.1007/s00535-003-1175-y

 

  1. Umehara H, Okazaki K, Masaki Y, et al., 2012, A novel clinical entity, IgG4-related disease (IgG4RD): General concept and details. Mod Rheumatol, 22(1): 1–14. https://doi.org/10.1007/s10165-011-0508-6

 

  1. Deshpande V, Zen Y, Chan JK, et al., 2012, Consensus statement on the pathology of IgG4-related disease. Mod Pathol, 25: 1181–1192. https://doi.org/10.1038/modpathol.2012.72

 

  1. Yu KH, Chan TM, Tsai PH, et al., 2015, Diagnostic performance of serum IgG4 levels in patients with IgG4-related disease. Medicine (Baltimore), 94: e1707. https://doi.org/10.1097/MD.0000000000001707

 

  1. Vasaitis L, 2016, IgG4-related disease: A relatively new concept for clinicians. Eur J Inter Med, 27: 1–9. https://doi.org/10.1016/j.ejim.2015.09.022

 

  1. Wallace ZS, Zhang Y, Perugino CA, et al., 2019, Clinical phenotypes of IgG4-related disease: An analysis of two international cross-sectional cohorts. Ann Rheum Dis, 78(3): 406–412. https://doi.org/10.1136/annrheumdis-2018-214603

 

  1. Teng F, Lu H, Zheng K, et al., 2020, Urinary system manifestation of IgG4-related disease: Clinical, laboratory, radiological, and pathological spectra of a Chinese single-centre study. J Immunol Res, 2020: 5851842. https://doi.org/10.1155/2020/5851842

 

  1. Bianchi D, 2016, IgG4-related disease: What urologists should know. Int Urol Nephrol, 48(3): 301–312. https://doi.org/10.1007/s11255-015-1189-4

 

  1. Lei WH, Xin J, Shao CX, et al., 2016, IgG4-related kidney disease mimicking malignant ureter tumor: Case report and literature review. Medicine (Baltimore), 95(3): e2550. https://doi.org/10.1097/MD.0000000000002550

 

  1. Zhong W, Kam J, Beattie K, et al., 2018, A rare case of ureteral IgG4 disease masquerading as urothelial carcinoma. Urology, 118: e1–e2. https://doi.org/10.1016/j.urology.2018.05.019

 

  1. Bissada NK, Finkbeiner AE, 1978, Idiopathic segmental ureteritis. Urology, 12(1): 64–66. https://doi.org/10.1016/0090-4295(78)90370-9

 

  1. Ueki Т, Miyake T, Narita M, et al., 2020, IgG4-related focal retroperitoneal fibrosis in ureter suggestive of colon cancer recurrence and resected laparoscopically: A case report. Surg Case Rep, 6: 197. https://doi.org/10.1186/s40792-020-00964-0

 

  1. Williams IS, Wang N, Bergamin P, et al., 2021, Peri-ureteric mass an unusual case of immunoglobin G4-related disease (IgG4-RD). Urol Case Rep, 38: 101666. https://doi.org/10.1016/j.eucr.2021.101666

 

  1. Lanzillotta M, Mancuso G, Della-Torre E, 2020, Advances in the diagnosis and management of IgG4 related disease. BMJ, 369: m1067. https://doi.org/10.1136/bmj.m1067

 

  1. Ebbo M, Grados A, Samson M, et al., 2017, Long-term efficacy and safety of rituximab in IgG4-related disease: Data from a French nationwide study of thirty-three patients. PLoS One, 12(9): e0183844. https://doi.org/10.1371/journal.pone.0183844

 

  1. Campochiaro C, Della-Torre E, Lanzillotta M, et al., 2020, Long-term efficacy of maintenance therapy with rituximab for IgG4-related disease. Eur J Intern Med, 74: 92–98. https://doi.org/10.1016/j.ejim.2019.12.029

 

  1. Buijs J, van Heerde MJ, Rauws EA, et al., 2014, Comparable efficacy of low-versus high-dose induction corticosteroid treatment in autoimmune pancreatitis. Pancreas, 43(2): 261–267. https://doi.org/10.1097/MPA.0000000000000044

 

  1. Tang J, Cai S, Ye C, et al., 2020, Biomarkers in IgG4-related disease: A systematic review. Semin Arthritis Rheum, 50(2):354–359. https://doi.org/10.1016/j.semarthrit.2019.06.018
Conflict of interest
The authors declare that they have no competing interests.
Share
Back to top
Tumor Discovery, Electronic ISSN: 2810-9775 Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept