Imaging and pathological features of gastric lesion of immunoglobulin G4-related disease: A case report and review of the recent literature

Figures & data

Figure 1. (a) Contrast-enhanced CT (axial image), (b) Contrast-enhanced CT (coronal image), (c) MRI; T2-weighted image (coronal image), and (d) Ultrasonographic image. Contrast-enhanced CT shows well-demarcated mass lesion in the antrum of the stomach (a: arrows). Reflecting the submucosal location of the lesion, gastric mucosa is described as strongly enhanced layer between the gastric lumen and mass lesion (b: arrow). The mass lesion shows homogeneous low intensity in MRI, and spared gastric mucosa is revealed as linear high intensity (c: arrows). In ultrasonography, the mass is described as homogeneous low echoic lesion and normal gastric mucosa is described as high echoic layer (d: arrows).

Figure 2. (a) Barium examination, (b) endoscopic image. Gastric lesion is described as compression of the gastric lumen (a: arrows) and submucosal mass projecting into the lumen at the antrum (b). Overlaying mucosa is normal on each examination.

Figure 3. Histopathological specimens of the resected gastric lesion (a–d): H&E staining, (e): Elastica-van Gieson staining, and (f): IgG4 staining. Resected mass is located in the submucosa extending to sub serosal region, and overlaying mucosa is preserved (a: arrows). The mass consists of diffuse lymphoplasmacytic infiltration (b), eosinophils (c: arrows), and dense fibrosis (d). Obliterative phlebitis is also noted (e). In immunostaining of IgG4, abundant IgG4-positive plasma cells are noted.

Table 1. Summary of reported cases of IgG4-related gastric lesion.

Study (Reference number)	Age	Gender	Involvement (mucosa/ submucosa)	Number/size of the lesion	Endoscopic findings	CT findings	Number of IgG4-positive cells	Serum IgG4 (mg/dL)	IgG4-related lesion at other sites	Treatment
Cheong HR et al. [19]	27	F	Submucosa	Single/3.4 cm	Submucosal mass with ulcer	Intramural mass	102/Hpf	Normal	None	Surgical resection
Rollins KE et al. [20]	75	F	Submucosa	Single/5.6 cm	Polypoid mass	Mass	39/Hpf	Normal	None	Surgical resection
Kim do H et al. [21]	59	F	Submucosa	Single/3.3 cm	Submucosal mass	Mass	>50/Hpf	Normal	None	Surgical resection
	54	F	Submucosa	Single/2.1 cm	Submucosal mass	Mass	>50/Hpf	Normal	None	Surgical resection
Baez JC et al. [22]	58	M	Mucosa and Submucosa	Single/1.4 cm	Wall edema and mild thickened folds	Nodular wall thickening	Dense infiltration	Normal	Salivary glands, pancreas, and kidney	Prednisolone
Kawano H et al. [23]	68	M	Submucosa	Single/1.5 cm	Submucosal mass	Submucosal mass	190/Hpf	1210	Lung, skin	Surgical resection
Kaji R et al. [25]	74	M	Mucosa	Multiple/NA	Multiple polyps with mucosal erosion and redness	NA	Dense infiltration	595	Pancreas, bile duct	NA
Inoue K et al. [26]	74	M	Submucosa	Diffuse/NA	Not detected (coexisting early gastric cancer)	Normal	232/Hpf	1120	Kidney	Surgical resection
Woo CG et al. [28]	48	F	Submucosa	Single/3.6 cm	Submucosal mass	Mass	210/Hpf/85%	NA	None	Surgical resection

NA: Not available.

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