IgG4-related lung disease showing high standardized uptake values on FDG-PET: Report of two cases
著者
北田, 正博
(Kitada, Masahiro)
Matsuda, Yoshinari
(Matsuda, Yoshinari)
Hayashi, Satoshi
(Hayashi, Satoshi)
Ishibashi, Kei
(Ishibashi, Kei)
Oikawa, Kensuke
(Oikawa, Kensuke)
Miyokawa, Naoyuki
(Miyokawa, Naoyuki)
Ohsaki, Yoshinobu
(Ohsaki, Yoshinobu)
上位タイトル
Journal of Cardiothoracic Surgery
Vol.25,
No.8
(2013.
6)
,p.160-
識別番号
ISSN
1749-8090
DOI
10.1186/1749-8090-8-160
その他
PMID:23800259
抄録
Immunoglobulin G4 (IgG4)-related lung disease is a disease in which IgG4-positive plasma cells and lymphocytes infiltrate lung tissues along with immunohistochemically evident fibrous interstitial proliferation in the background, in addition to hyper-IgG4 disease. The diagnosis of this disease can be difficult. Here, we report 2 cases with IgG4-related lung disease that was difficult to differentiate from malignant tumors because both cases had pulmonary lesions showing high standardized uptake values (SUV) on positron emission tomography (PET). Case 1: A 75-year-old man under treatment for autoimmune pancreatitis and diabetes mellitus was noted to have multiple nodular opacities in both lungs and a mass density in the right paravertebral region on computed tomography (CT). As high SUVmax was noted for both lesions on exploration by fluorodeoxyglucose (FDG)-PET/CT, an advanced malignant tumor was diagnosed and a video-assisted thoracoscopic (VATS) biopsy was performed and diagnosed IgG4-related lung disease. Case 2: A 48-year-old woman consulted our clinic with a chief complaint of bloody sputum. Chest CT revealed a mass density with 12-, 13-, and 16-mm spiculations in the S2 segment of the right upper lobe and irregular thickening of the pleura including the paravertebral region. The lesion was a mass showing high SUV in the S2 segment on FDG-PET. Malignancy was suspected from the imaging findings, and a VATS biopsy was performed and diagnosed IgG4-related lung disease. Actively undertaking VATS biopsy in cases with this disease is valuable for making the differential diagnosis between malignant tumors and IgG4-related lung disease, since the diagnosis can be difficult in some patients showing high SUV.
