Igg4 Pseudo tumors Mimicking Urologic Malignancies: Comprehensive Review and Management of a Rare Infiltrative Upper Tract Lesion
Journal Title: International Journal of Surgery & Surgical Techniques - Year 2023, Vol 7, Issue 2
Abstract
Objectives: Immune-mediated fibroinflammatory conditions are known to affect multiple organ systems, as seen in the IgG-4 related disease. While tubulointerstitial nephritis and membranous glomerulonephritis are the more common intrinsic renal diseases, IgG-4 mediated disease can mimick urologic malignancies and can pose a significant management dilemma. Our goal is to understand how to better diagnose, exclude malignancy, and preserve renal function in a rare Urologic disease. Materials and Methods: A review of current literature was obtained to provide additional insight and understanding on this rarely observed Urologic disease. In discussing the case presented, a pertinent clinical history, physical exam, and review of cross-sectional imaging is presented. Immunohistochemical analysis of the specimen was thoroughly performed with expert analysis by our consulting pathologist. Results: Very rare reports of renal, ureteral, pelvic, or scrotal IgG4 mediated pseudotumors have been published. In the absence of pathologic tissue analysis of biopsy samples, the diagnosis of this rare disease can be significantly challenging. In our presentation, a male patient was noted to have a 7cm mass replacing the left renal sinus and causing moderate left hydronephrosis. Initial concern was for upper tract urothelial cell carcinoma. However, left ureteropyeloscopy demonstrated normal left renal and ureteral architecture and excisional biopsy of a PET avid left cervical lymph node was performed however pathologic diagnosis was not able to be confirmed. This led to a management dilemma due to the progressing mass size, worsening renal drainage, and symptoms. The patient opted for surgical excision. Final pathology from a left radical nephrectomy was significant for an IgG-4 related inflammatory pseudotumor. Conclusions: IgG-4 related diseases are known to represent a systemic disease that leads to lymphoplasmacystic inflammation and fibrosis within the affected tissues. At this time, there is no standardized method for the diagnosis and treatment of patients with retroperitoneal involvement. Additional research is needed to identify improved diagnostic modalities, the role of immunosuppressive therapy, and the surgical management in this disease process.
Authors and Affiliations
Boehm B, Mezhiritsky V, Sesterhenn IA, Chesnut G and Kern SQ*
Keywords
Related Articles
- EP ID EP748263
- DOI 10.23880/ijsst-16000183
- Views 35
- Downloads 0
Subplatysmal Endoscopic Guided Endotracheal Tube Cuff Inflation Facilitates Working Space Creation in Transoral Endoscopic Thyroidectomy, A Novel Technique
Transoral endoscopic thyroidectomy is a natural orifice thyroid surgery, minimally invasive and completely scar free. However, the working space of this procedure is relatively small and is also difficult to create comp...
Torsion of the Spermatic Cord in Children at the Brazzaville University and Hospital Center
The purpose of our study is to analyze the epidemiological, clinical and therapeutic aspects of spermatic cord torsion. Materials and methods: This is a retrospective cross-sectional descriptive study conducted in the p...
The Interest of the Modified Lateral Supramalleolar Flap in the Management for Defect of Ankle
Covering the defect of ankle substances as well as the defect of distal leg substances has long been a challenge for plastic surgeons. Through the experience of two clinical cases, we show the ease of survey, the clinic...
Management of Complications of Digestive Endoscopic Procedures: A Review
Endoscopic procedures are currently a fundamental tool in the diagnosis and treatment of numerous digestive pathologies. They form part of the minimally invasive management of many pathologies, avoiding numerous surgeri...
Telemedicine for the Surgical Management of Abdominal Trauma in the District Hospitals
The outcomes of the 51 patients with blunt abdominal trauma after the car crash treated in the district hospital were analyzed. 25 patients in a basic group, underwent surgery during which the distant specialist consult...