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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
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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/ )
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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
Conflict of interest
The authors declare that they have no competing interests.
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Tumor Discovery, Electronic ISSN: 2810-9775 Print ISSN: 3060-8597, Published by AccScience Publishing
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