Clin Endosc.  2016 Mar;49(2):197-201. 10.5946/ce.2015.074.

Immunoglobulin G4-Related Inflammatory Pseudotumor Presenting as a Solitary Mass in the Stomach

  • 1Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.


Immunoglobulin G4 (IgG4)-related disease (IgG4RD) is a relatively recently recognized entity that is histopathologically characterized by an extensive infiltration of lymphocytes and IgG4-positive plasma cells with dense fibrosis. IgG4RD is now known to affect any organ system, and a few cases of gastrointestinal lesions have also been reported. However, solitary IgG4RD of the stomach is still very rare. Furthermore, as it can mimic malignant conditions, it is important to recognize this disease to avoid unnecessary surgery. Herein, we present a case of IgG4RD presenting as an isolated subepithelial mass in the stomach.


Immunoglobulin G4-related sclerosing disease; Pseudotumor; Stomach

MeSH Terms

Granuloma, Plasma Cell*
Plasma Cells
Unnecessary Procedures


  • Fig. 1. Abdominal computed tomography images showing multiple cysts in both kidneys (A) and an intramural enhancing mass in the gastric fundus (B).

  • Fig. 2. Endoscopic findings. (A) Helicobacter pylori-positive lymphofollicular gastritis. (B) An approximately 4-cm, hard, fixed subepithelial mass with distinct ulceration on the surface, located in the fundus. (C) Endoscopic ultrasonography image showing a 3.4×1.6 cm homogeneous hypoechoic mass located in the muscularis mucosa up to the submucosa.

  • Fig. 3. Gross findings after formalin fixation. (A, B) On the specimen section, a well-defined homogeneous gray-white solid submucosal mass (asterisks) is identifiable. The gastric mucosa (arrows) is unremarkable.

  • Fig. 4. Pathologic findings. (A) Dense fibrosis admixed with inflammatory cells composing the submucosal mass that extends to the subserosa (asterisk, mucosa; arrowhead, submucosa; circle, muscularis propria; H&E stain, ×12.5). (B) Bland-looking spindle cells arranged in a storiform pattern (H&E, ×200). (C) Fibroblastic cells admixed with dense lymphoplasmacytic cells (H&E, ×400). (D) Immunoglobulin G (IgG) immunohistochemical staining showing increased numbers of IgG-positive plasma cells in the stroma (402/high power field [HPF], ×200). (E) IgG4 immunohistochemical staining revealing increased numbers of IgG4-positive plasma cell infiltration (102/HPF, ×200); the ratio of IgG4+/IgG+ plasma cells was 25.3%.

Cited by  2 articles

IgG4-related Disease in the Stomach which Was Confused with Gastrointestinal Stromal Tumor (GIST): Two Case Reports and Review of the Literature
Ho Seok Seo, Yoon Ju Jung, Cho Hyun Park, Kyo Young Song, Eun Sun Jung
J Gastric Cancer. 2018;18(1):99-107.    doi: 10.5230/jgc.2018.18.e8.

Gastric IgG4-related disease presenting as a mass lesion and masquerading as a gastrointestinal stromal tumor
Banumathi Ramakrishna, Rohan Yewale, Kavita Vijayakumar, Patta Radhakrishna, Balakrishnan Siddartha Ramakrishna
J Pathol Transl Med. 2020;54(3):258-262.    doi: 10.4132/jptm.2020.02.10.


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