title: IgG4-related periureteral fibrosis presenting as a unilateral ureteral mass.
abstract: IgG4-related sclerosing disease is a rare disease characterized by fibrosis and lymphoplasmacytic infiltration in various organs. Here, we report a rare case of IgG4-related fibrosis that presented as a unilateral ureteral mass in a 39-year-old man who presented with abdominal pain. Left hydronephrosis and a mass measuring 3 × 1.1 cm in the lower portion of the left ureter were found. As a ureteral malignancy could not be ruled out, the left ureter was resected partially. Pathologically, severe fibrosis and infiltration of plasma cells, lymphocytes, and eosinophils were found. No malignancy was found. Immunohistochemically, most of the plasma cells were IgG4-positive. The serum IgG4 level was also elevated (233 mg/dl). The histological characteristics were similar to those of retroperitoneal fibrosis, inflammatory pseudotumor, or idiopathic segmental ureteritis. It is important to consider IgG4-related sclerosing disease in the differential diagnosis of a unilateral ureteral mass.
authors.affiliation: Department of Pathology, Asahi General Hospital, Chiba, Japan. hiroyuki-abe-1101@yd6.so-net.ne.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Abe
authors.forename: Teppei
authors.initials: T
authors.lastname: Morikawa
authors.forename: Akinobu
authors.initials: A
authors.lastname: Araki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shima
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Nakatsu
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004804:Eosinophils; D006104:Granuloma, Plasma Cell / Q000473:pathology; D006801:Humans; D006869:Hydronephrosis / Q000473:pathology* / Q000601:surgery; D007074:Immunoglobulin G / Q000378:metabolism*; D007150:Immunohistochemistry; D008214:Lymphocytes; D008297:Male; D010950:Plasma Cells / Q000276:immunology* / Q000473:pathology; D012185:Retroperitoneal Fibrosis / Q000473:pathology; D012598:Sclerosis / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology* / Q000601:surgery; D014515:Ureteral Diseases / Q000473:pathology* / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology
chemical_list: D007074:Immunoglobulin G