IgG4-related brain pseudotumor mimicking CNS lymphoma. A case report.
Rie OshimaRyotaro IkeguchiSho WakoTakafumi MizunoKayoko AbeMasayuki NittaYoshihiro MuragakiTakakazu KawamataKenta MasuiTomoko YamamotoNoriyuki ShibataYuko ShimizuKazuo KitagawaPublished in: Neuropathology : official journal of the Japanese Society of Neuropathology (2022)
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.
Keyphrases
- positron emission tomography
- contrast enhanced
- computed tomography
- diffuse large b cell lymphoma
- resting state
- white matter
- magnetic resonance imaging
- diffusion weighted
- cerebrospinal fluid
- blood brain barrier
- case report
- low dose
- deep learning
- healthcare
- functional connectivity
- cerebral ischemia
- pet ct
- magnetic resonance
- single cell
- convolutional neural network
- pet imaging
- optical coherence tomography
- oxidative stress
- amino acid
- mitral valve
- high dose
- physical activity
- machine learning
- subarachnoid hemorrhage
- spinal cord
- left ventricular
- cell proliferation
- heart failure
- stem cells
- spinal cord injury
- cell therapy
- coronary artery
- bone marrow
- neuropathic pain
- fine needle aspiration