Intracranial Multiple Pseudotumor Due to Immunoglobulin G4-Related Disease without Other Lesions: Case Report and Literature Review

被引:10
作者
Kuroda, Naoto [1 ]
Inenaga, Chikanori [1 ]
Arai, Yoshifumi [2 ]
Otsuki, Yoshiro [2 ]
Tanaka, Tokutaro [1 ]
机构
[1] Seirei Hamamatsu Gen Hosp, Dept Neurosurg, Hamamatsu, Shizuoka, Japan
[2] Seirei Hamamatsu Gen Hosp, Dept Pathol, Hamamatsu, Shizuoka, Japan
关键词
IgG4-related disease; Intracranial; Intradural; Operation; Pathology; Pseudotumor; Surgery; IGG4-RELATED DISEASE; INFLAMMATORY PSEUDOTUMOR; FEATURES; NECK; HEAD;
D O I
10.1016/j.wneu.2019.08.127
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Immunoglobulin (Ig)G4-related disease (IgG4-RD) was defined only recently and can be found in many organs. As intracranial lesions, hypophysitis and pachymeningitis are well known, whereas intracranial pseudotumor is unusual. This case involved multiple intracranial pseudotumors without extracranial lesions, mimicking multiple meningioma. CASE DESCRIPTION: A 72-year-old woman was referred to our hospital with an incidental mass lesion at the craniocervical junction on magnetic resonance imaging (MRI). MRI showed diffuse enhanced extra-axial nodules around the medulla and middle cranial fossa. Surgery was performed for the gradually enlarging tumor. Intraoperative findings showed hard nodules around the vertebral artery. We performed subtotal resection. Neuropathological findings showed diffuse lymphoplasmacytic infiltration with lymphoid follicles. Immunohistochemical studies for IgG4 and IgG showed the histological criteria for IgG4-RD were met. Given the high IgG4 serum level, we diagnosed IgG4-RD. Steroid was administered initially but was then tapered, and nodules have since remained small. CONCLUSIONS: This case demonstrates IgG4-RD mimicking meningioma with multiple masses but without extracranial lesions. This case and previous descriptions suggest the possibility of pseudotumor due to IgG4-RD in the presence of multiple extra-axial lesions at the dura and supplying artery, hard nodules with thickening of the artery, and frozen section findings of lymphoplasmacytes surrounded by rich collagen fibers. In such cases, the pseudotumor due to IgG4-RD should be resected, and total resection might not be warranted.
引用
收藏
页码:69 / 74
页数:6
相关论文
共 23 条
[1]   The clinical spectrum of IgG4-related disease [J].
Brito-Zeron, Pilar ;
Ramos-Casals, Manuel ;
Bosch, Xavier ;
Stone, John H. .
AUTOIMMUNITY REVIEWS, 2014, 13 (12) :1203-1210
[2]   Immunology of IgG4-related disease [J].
Della-Torre, E. ;
Lanzillotta, M. ;
Doglioni, C. .
CLINICAL AND EXPERIMENTAL IMMUNOLOGY, 2015, 181 (02) :191-206
[3]  
Deshpande V, 2013, Diagn Histopathol, V19, P119, DOI [10.1016/j.mpdhp.2013.01.004, DOI 10.1016/J.MPDHP.2013.01.004]
[4]   IgG4-related intracranial disease [J].
Goulam-Houssein, Shahine ;
Grenville, Jeffrey L. ;
Mastrocostas, Katerina ;
Munoz, David G. ;
Lin, Amy ;
Bharatha, Aditya ;
Vlachou, Paraskevi A. .
NEURORADIOLOGY JOURNAL, 2019, 32 (01) :29-35
[5]   IgG4-related diseases [J].
Guma, Monica ;
Firestein, Gary S. .
BEST PRACTICE & RESEARCH IN CLINICAL RHEUMATOLOGY, 2012, 26 (04) :425-438
[6]   IgG4-related disease [J].
Kamisawa, Terumi ;
Zen, Yoh ;
Pillai, Shiv ;
Stone, John H. .
LANCET, 2015, 385 (9976) :1460-1471
[7]   IgG4-Related Arterial Disease [J].
Kasashima, Fuminori ;
Kawakami, Kengo ;
Matsumoto, Yasushi ;
Endo, Masamitsu ;
Kasashima, Satomi ;
Kawashima, Atsuhiro .
ANNALS OF VASCULAR DISEASES, 2018, 11 (01) :72-77
[8]  
Katsura M, 2011, AJNR Am J Neuroradiol, V32, pE150, DOI 10.3174/ajnr.A2256
[9]   Radiological features of IgG4-related disease in the head, neck, and brain [J].
Katsura, Masaki ;
Mori, Harushi ;
Kunimatsu, Akira ;
Sasaki, Hiroki ;
Abe, Osamu ;
Machida, Toru ;
Ohtomo, Kuni .
NEURORADIOLOGY, 2012, 54 (08) :873-882
[10]   Immunoglobulin G4-related hypertrophic pachymeningitis involving cerebral parenchyma Case report [J].
Kim, Eui Hyun ;
Kim, Se Hoon ;
Cho, Jin Mo ;
Ahn, Jung Yong ;
Chang, Jong Hee .
JOURNAL OF NEUROSURGERY, 2011, 115 (06) :1242-1247