Abstract YO13
Case summary
Background: Immunoglobulin G4 (IgG4)-related disease is a rare immune-mediated fibroinflammatory condition, characterized by infiltration of IgG4 positive plasma cells and storiform fibrosis. The clinical presentation included fibrosis of affected organs and pseudotumor formation occasionally mimic malignancy.
Aims: To present a case of IgG4-related kidney disease mimicking renal cell carcinoma
Method: Case report
Result: 53-year-old male with an unremarkable previous medical history presented with painless gross hematuria, fever and anemic symptom for 3 months. Laboratory tests showed microcytic anemia, normal creatinine levels and numerous white blood cells in urine. CT chest and abdomen revealed an infiltrative heterogenous hypoenhancing lesion at right kidney size 7.5 x7.9 x8.5cm, a hypoenhancing lesion in hepatic segment IVa/VIII size 6.8x3.8 cm, diffuse intraabdominal lymph node enlargement up to 1.8 cm and multiple lung nodules. The initial clinical and radiologic findings were highly suggestive of malignancy. The differential diagnosis is renal cell carcinoma and lymphoma. Liver biopsy was performed and shown chronic inflammation and fibrosis. Subsequently renal biopsy was done and revealed chronic interstitial nephritis, focal interstitial fibrosis and prominent plasma cell infiltration. Immunohistochemistry from renal biopsy revealed positive for CD20, CD3, CD38, CD138, IgG (210 cells/HPF) and IgG4/IgG-positive cell ratio was 54%. In situ hybridization for kappa and lambda light chain showed polyclonal plasma cell with kappa to lambda ratio of 4:1. Serum IgG4 level was more than 5,840 mg/dL. These findings made diagnosis of IgG4 related kidney disease. Prednisolone 60 mg/day was given and gradually reduced to 10 mg five months thereafter. After 3 months of therapy, a follow-up CT scan showed decrease size of right renal mass to 6.1 x7.3 x6.2 cm, nearly complete resolved of liver lesion and some prior pulmonary nodules.
Conclusion: IgG4 related kidney disease can present with pseudotumor and can be misdiagnosed as a malignant tumor. Awareness of this condition and proper investigation including histopathology and serum IgG4 level should be considered in case of highly suggestive patient.
Clinical trial identification
Editorial acknowledgement
Resources from the same session
517P - High BRCA1 expression is independently correlated with decreased overall survival in lung adenocarcinoma: Evidence from meta and bioinformatics analyses
Presenter: Fengzhu Guo
Session: Poster display session
Resources:
Abstract
528P - High-biologically effective dose radiotherapy may improve local control of small cell lung cancer patients with brain metastases: A propensity-matching analysis
Presenter: Qingyang Zhuang
Session: Poster display session
Resources:
Abstract
530P - Prognostic value of C-reactive protein, albumin and C-reactive protein to albumin ratio in small cell lung cancer: A meta-analysis
Presenter: Carla Emille Barbon
Session: Poster display session
Resources:
Abstract
531TiP - CANOPY-A: A phase III, placebo-controlled study of canakinumab as adjuvant therapy in patients (pts) with surgically resected NSCLC
Presenter: Byoung Chul Cho
Session: Poster display session
Resources:
Abstract
532TiP - CANOPY-1: A phase III, placebo-controlled study of pembrolizumab (PEM) plus platinum-based doublet chemotherapy (Ctx) with/without canakinumab in untreated patients (pts) with stage IIIB/IIIC-IV NSCLC
Presenter: Daniel Shao Weng Tan
Session: Poster display session
Resources:
Abstract
533TiP - CANOPY-2: A phase III, placebo-controlled study of canakinumab with or without docetaxel in patients (pts) with NSCLC previously treated with PD-(L)1 inhibitors and platinum-based chemotherapy (Ctx)
Presenter: Darren Lim
Session: Poster display session
Resources:
Abstract
534TiP - A randomized phase III study of carboplatin plus nab-paclitaxel with or without nintedanib for NSCLC with IPF (J-SONIC)
Presenter: Kohei Otsubo
Session: Poster display session
Resources:
Abstract
535TiP - Phase II study of atezolizumab for pretreated advanced / recurrent non-small cell lung cancer with idiopathic interstitial pneumonia (TORG1936 / AMBITIOUS study)
Presenter: Satoshi Ikeda
Session: Poster display session
Resources:
Abstract
536TiP - INSIGHT 2: Tepotinib plus osimertinib in patients with EGFR-mutant NSCLC having acquired resistance to EGFR TKIs due to MET-amplification: A phase II trial in progress study
Presenter: James C-H Yang
Session: Poster display session
Resources:
Abstract
YO8 - Carcinosarcoma of the Breast in a Filipino Female: A Case Report
Presenter: Ma. Angelle Lalaine Dantes
Session: Poster display session
Resources:
Abstract