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ニツタ マサユキ
NITTA Masayuki
新田 雅之 所属 医学部 医学科（東京女子医科大学病院） 職種 助教 |
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| 論文種別 | 症例報告 |
| 言語種別 | 英語 |
| 査読の有無 | 査読あり |
| 表題 | IgG4-related brain pseudotumor mimicking CNS lymphoma. A case report. |
| 掲載誌名 | 正式名：Neuropathology : official journal of the Japanese Society of Neuropathology 略 称：Neuropathology ISSNコード：14401789/09196544 |
| 掲載区分 | 国外 |
| 巻・号・頁 | 42(6),pp.526-533 |
| 著者・共著者 | OSHIMA Rie†, IKEGUCHI Ryotaro, WAKO Syo, MIZUNO Takafumi, ABE Kayoko†, NITTA Masayuki, MURAGAKI Yoshihiro, KAWAMATA Takakazu, MASUI Kento, YAMAMOTO Tomoko, SHIBATA Noriyuki, SHIMIZU Yuko, KITAGAWA Kazuo |
| 発行年月 | 2022/12 |
| 概要 | Here, we report a case of IgG4-related brain pseudotumor (IgG4-BP) in a 39-year-old woman, mimicking central nervous system (CNS) lymphoma. She presented with headache, fever, and fatigue. Her medical history was notable for appearance of a tumefactive brain lesion seven years before. Brain biopsy performed at the age of 32 revealed nonspecific inflammatory changes, and her condition improved with oral low-dose steroid therapy. Magnetic resonance imaging performed at the age of 39 identified a hyperintensity lesion with edema located at the medial temporal lobe region adjacent to the inferior horn of the left lateral ventricle on fluid-attenuated inversion recovery images, which showed gadolinium-contrast enhancement on T1-weighted images and a slightly hyperintensity signal on diffusion-weighted images. Methionine-positron emission tomography (PET) depicted a high methionine uptake in the lesion. Additionally, soluble levels of interleukin (IL)-2 receptor (sIL-2R) and IL-10 were increased in cerebrospinal fluid (CSF). Based on these findings, we suspected CNS lymphoma and performed partial resection of the brain lesion. Pathological examination revealed prominent lymphocytic infiltration associated with plasma cell infiltration. Most of the plasma cells were immunoreactive for IgG4. Storiform fibrosis and partially obliterative phlebitis were concomitantly observed. Thus, the patient was diagnosed as having IgG4-BP. To the best of our knowledge, this is the first case report of IgG4-BP with detailed findings obtained by CSF testing, methionine-PET, and pathological examination. Because IgG4-related diseases can present as a pseudotumor that mimics CNS lymphoma, it is essential to carefully differentiate IgG4-BP from CNS lymphoma. |
| DOI | 10.1111/neup.12839 |
| PMID | 36210695 |