Detailed Abstract
[E-poster - Biliary & Pancreas (Biliary Disease/Surgery)]
[EP 103] Isolated IgG-4 Related Gallbladder Disease – Mimicker Of Gall Bladder Cancer: A Case Report.
Prashanth B*1 , Venu Madhav THUMMA1 , Phani Kumar N1 , Bheerappa NAGARI1 , Suryaramachandra Varma GUNTURI1 , Nava Kishore K1 , Sukanya B2 , Megha S UPPIN3
1 Surgical Gastroenterology, Nizam's Institute Of Medical Sciences, Hyderabad, INDIA
2 Medical Gastroenterology, Nizam's Institute Of Medical Sciences, Hyderabad, INDIA
3 Pathology, Nizam's Institute Of Medical Sciences, Hyderabad, INDIA
Background : Immunoglobulin G4-related disease is an immune mediated fibro-inflammatory condition that can affect multiple organs. IgG-4 related gallbladder disease (RGBD) is a rare entity, mostly associated with IgG4 autoimmune pancreatitis. However, Isolated IgG G4 gallbladder disease is rarely described in the literature.
Methods : We describe a rare case report of an isolated IgG4 Gallbladder disease.
Results : A 30-year-old female presented with epigastric pain for 6 months. On clinical examination right upper quadrant tenderness was noted. The liver function tests showed obstructive pattern. On computed tomography, an ill-defined heterogeneously enhancing soft tissue lesion arising from gallbladder was noted. The differential diagnoses were carcinoma of gallbladder, xanthogranulomatous cholecystitis. Intra-operatively, a thick-walled gallbladder with dense adhesions with duodenum and transverse colon was observed. Intra-operative frozen sections from mass lesion showed no evidence for malignancy. Cholecystectomy and Roux-en-Y hepaticojejunostomy was performed. On pathological examination, lymphoid aggregates throughout the wall of gallbladder were noted. There were areas showing dense inflammation with fibrotic area comprised of predominately plasma cells along with admixed with lymphocytes. Hepato-duodenal-ligament lymph node showing inflammatory infiltrate predominately comprised of plasma cells and lymphocytes. On immune-histochemistry, IgG was positive in plasma cells; IgG4 was positive in plasma cells and IgG4 to IgG ratio – 0.66 (60%) was observed. Serum IgG 4 levels after surgery were 1057 mg/L. She was treated with steroids post-operatively.
Conclusions : It is very difficult to obtain preoperative diagnosis of IgG4-RGBD and is difficult to differentiate from gallbladder malignancy.
Methods : We describe a rare case report of an isolated IgG4 Gallbladder disease.
Results : A 30-year-old female presented with epigastric pain for 6 months. On clinical examination right upper quadrant tenderness was noted. The liver function tests showed obstructive pattern. On computed tomography, an ill-defined heterogeneously enhancing soft tissue lesion arising from gallbladder was noted. The differential diagnoses were carcinoma of gallbladder, xanthogranulomatous cholecystitis. Intra-operatively, a thick-walled gallbladder with dense adhesions with duodenum and transverse colon was observed. Intra-operative frozen sections from mass lesion showed no evidence for malignancy. Cholecystectomy and Roux-en-Y hepaticojejunostomy was performed. On pathological examination, lymphoid aggregates throughout the wall of gallbladder were noted. There were areas showing dense inflammation with fibrotic area comprised of predominately plasma cells along with admixed with lymphocytes. Hepato-duodenal-ligament lymph node showing inflammatory infiltrate predominately comprised of plasma cells and lymphocytes. On immune-histochemistry, IgG was positive in plasma cells; IgG4 was positive in plasma cells and IgG4 to IgG ratio – 0.66 (60%) was observed. Serum IgG 4 levels after surgery were 1057 mg/L. She was treated with steroids post-operatively.
Conclusions : It is very difficult to obtain preoperative diagnosis of IgG4-RGBD and is difficult to differentiate from gallbladder malignancy.
SESSION
E-poster
E-Session 03/23 ~ 03/25 ALL DAY