Laparoscopic Resection for Colonic Obstruction Due to Immunoglobulin G4-Related Disease: A Case Report

TL;DR

An 89-year-old woman with colonic obstruction was found to have IgG4-related disease, not cancer, after undergoing laparoscopic surgery and detailed histological analysis.

Contribution

This case highlights the importance of considering IgG4-related disease in the differential diagnosis of colonic obstruction.

Findings

Histopathology revealed severe fibrosis and chronic inflammation, not malignancy.

IgG4-positive cells exceeded diagnostic thresholds, supporting an IgG4-related disease diagnosis.

Postoperative serum IgG4 levels were normal, indicating a probable rather than definite diagnosis.

Abstract

An 89-year-old woman was referred to our hospital with complaints of body weight loss and anemia. Lower gastrointestinal imaging revealed a 3.5-cm stenosis in the descending colon near the splenic flexure. Endoscopy did not pass through the stricture. A biopsy showed no evidence of malignancy or lymphoma. Enhanced abdominopelvic computed tomography showed a thickened descending colon wall with swollen lymph nodes around the colon. Because descending colon cancer was suspected, laparoscopic-assisted left hemicolectomy with D2 lymph node dissection was performed. Hematoxylin and eosin staining showed severe fibrosis and chronic inflammatory cell infiltration. Immunohistochemistry staining showed the number of immunoglobulin G4 (IgG4)-positive cells at 100/high-power field (400×), and the IgG4/IgG ratio was >40%. The serum IgG4 level was measured postoperatively and was within the normal range at 54 mg/dL. The patient was diagnosed as a probable group of IgG4-related disease based on the comprehensive clinical diagnostic criteria for IgG4-related disease.

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