Abstract
Abstract
Background
Increased usage of cross sectional imaging for a variety of indications, in particular CT imaging, has led to an increased detection of renal and ureteric masses. Benign ureteric masses are rare, with 95% of identified tumours consisting of transitional cell carcinoma (TCC). IgG4-related disease is a recognised clinical systemic autoimmune, inflammatory condition with a propensity for multi-organ manifestation. Nephritis and pseudo-tumour formation can occur when kidneys are involved. Ureteric involvement is more rare.
Case presentation
Forty nine-year-old Korean male was found to have an incidental invasive renal pelvis mass during investigation for chronic back pain and fatigue. Appearance of the tumour was consistent with an invasive malignancy, and consensus from multidisciplinary meeting was to have the tumour removed. Procedure involved a prolonged open surgery with reconstruction of contralateral renal blood supply and was complicated by a long recovery process. Final histopathology confirmed IgG4 renal pseudo tumour diagnosis.
Conclusion
IgG4-related disease is a rare but potentially morbid disease that can mimic various cancers, including lung, pancreas and renal malignancies. A high index of suspicion is required to accurately diagnose this condition, through a targeted history taking, examination and investigation which should include biopsies. Failing to do so may result in unnecessary procedures being performed and exposing a patient to its associated risks.
Key Questions about IgG4-Related Renal Pseudotumors
The article "An uncommon mimicker of renal malignancy: IgG4-related disease" discusses a case where IgG4-related disease presented as a renal mass, leading to unnecessary surgical intervention. The patient, a 49-year-old male, underwent an open right radical nephroureterectomy due to a suspected invasive renal malignancy. Postoperative histopathology revealed an IgG4-related renal pseudotumor. This case underscores the importance of considering IgG4-related disease in the differential diagnosis of renal masses to prevent unnecessary surgeries.
1. What is IgG4-related disease, and how can it mimic renal malignancy?
IgG4-related disease is a systemic autoimmune condition characterized by inflammation and fibrosis in multiple organs. When it affects the kidneys, it can present as a mass resembling renal malignancy, leading to potential misdiagnosis.
2. How was the diagnosis of IgG4-related disease established in this case?
The diagnosis was confirmed through histopathological examination of the surgical specimen, which revealed features consistent with IgG4-related disease. This highlights the necessity of considering this condition in the differential diagnosis of renal masses.
3. What are the implications for clinical practice regarding the diagnosis and management of IgG4-related renal pseudotumors?
Clinicians should maintain a high index of suspicion for IgG4-related disease in patients presenting with renal masses, especially when imaging findings suggest malignancy. Early recognition can prevent unnecessary surgical interventions and guide appropriate medical management, such as corticosteroid therapy.
