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IgG4-related disease of the ureter DOI: 10.29188/2222-8543-2021-14-4-56-62
Anikanova E.V., Yagudaev D.M., Firsov K.A., Levenduk O.A., Samoilova S.I., Gens G.P., Lischuk S. V. IgG4-associated ureteral disease. Experimental and Clinical Urology, 2021;14(4):56-62; https://doi.org/10.29188/2222-8543-2021-14-4-56-62
Anikanova E.V., Yagudaev D.M., Firsov K.A., Levenduk O.A., Samoilova S.I., Gens G.P., Lischuk S. V.
Information about authors:
Anikanova E.V. – PhD, oncourologist, Department of Oncology (urology), Central clinical hospital «Russian Railways-Medicine»; Department of Oncology and Radiology A.I. Evdokimov Moscow State University of Medicine and Dentistry, https://orcid.org/0000-0001-8524-129X
Yagudaev D.M. – Dr. Sc., Head of the Department of Oncology (urology), Central clinical hospital «Russian Railways-Medicine», Professor of Department of Endoscopic Urology of The Peoples' Friendship University of Russia, https://orcid.org/0000-0002-5949-6915
Firsov K.A. – PhD, oncourologist, Department of Oncology (urology), Central clinical hospital «Russian Railways-Medicine»; https://orcid.org/0000-0002-4626-1295
Levenduk O.A. – PhD, Head of the laboratory of immunohistochemical and molecular genetic research methods of Centralized pathological Central clinical hospital «Russian Railways-Medicine», Moscow, Russia
Samoilova S.I. – PhD, Head of the Centralized pathological Central clinical hospital «Russian Railways-Medicine», Associate Professor of the Department of Oncology, Radiotherapy and Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; https://orcid.org/0000-0003-4598-8625
Guens G.P. – Dr. Sc., Professor, Head of the of Oncology and Radiology A.I. Evdokimov Moscow State University of Medicine and Dentistry, https://orcid.org/0000-0001-8708-2712
Lishchuk S.V. – pathologist, head of pathology Department, research SSC center named of A.I. Burnazyan of FMBA of Russia, PhD Med; Moscow, Russia; https://orcid.org/0000-0003-0372-5886
Introduction. IgG4-associated diseases are a systemic immune-dependent pathology characterized by diffuse or focal infiltration of affected tissues by lymphocytes and plasma cells expressing IgG4, followed by the development of phlebitis and fibrosclerosis in the affected tissues. In extremely rare cases, an IgG4-associated disease affects the ureter that mimics its malignant tumor, which presents a diagnostic challenge. We present a rare case of IgG4-associated iwhich was misdiagnosed as ureter tumor.
Clinical observation. Patient P. Sixty four years old patient admitted for left lower back pain and weight loss by (4 kg for the last 2 months). There were a stenosing tumor at the border of middle and lower parts of left ureter, left-side hydronephrosis and retroperitoneal lymphadonopathy on computed tomography. Uretelial cancer was suspected and nephroureterectomy with lymphadenectomy was done. Pathomorphological study revealed fibrosis, periflebitis with narrowing of veins and venules, diffuse inflammatory infiltration by lymphocytes, plasma cells and epsinophils in the ureter wall. There were no tumor growth there. Immunohistochemical staining revealed the presence of IgG4- positive plasma cells in the altered ureter wall. There was also an encreased IgG4 level up to 1,49 g/L in the patient’s serum.
Conclusion. An IgG4-associated disease of the ureter was diagnosed at the pathological study of removed kidney and ureter. It is necessary to take into account the possibility of IgG4-associated disease in patients with ureteral neoplasms. It makes possible to do a proper diagnose and avoid unjustified surgery