title: Neoplasm mimics of rheumatologic presentations: sialadenitis, ocular masquerade syndromes, retroperitoneal fibrosis, and regional pain syndromes.
abstract: IgG4-RSD should be suspected in any patient presenting with lacrimal or salivary gland enlargement, particularly if male and manifesting mild glandular dysfunction. A serum IgG4 level, if increased, may be helpful, although a gland biopsy staining for IgG4-positive plasma cells is the definitive test. Primary low-grade B cell lymphomas of the glandular tissue, specifically MALT lymphoma and other glandular malignancy, should be considered, particularly in patients with asymmetric glandular enlargement. Patients with idiopathic uveitis should have a thorough evaluation to exclude malignancy, in particular PIOL and melanoma in adults, and diffuse retinoblastoma and ALL in children. RF remains a diagnostic challenge and atypical features such as outward displacement of the retroperitoneal structures should raise the suspicion for a malignant infiltrative process. CRPS rarely may be the first presentation of an occult malignancy and requires a thorough review of age-appropriate cancer screening. Carpal tunnel syndrome, if bilateral or associated with other systemic features, should prompt a search for amyloidosis.
authors.affiliation: Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland Veterans Affairs Medical Center, 3181 SW Sam Jackson Park Road, OP09, Portland, OR 97239, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lipton
authors.forename: Pascale
authors.initials: P
authors.lastname: Schwab
mesh_terms: D020918:Complex Regional Pain Syndromes / Q000175:diagnosis* / Q000276:immunology; D003937:Diagnosis, Differential; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000276:immunology; D020364:Paraneoplastic Polyneuropathy / Q000175:diagnosis* / Q000276:immunology; D010265:Paraproteinemias / Q000175:diagnosis / Q000276:immunology; D012185:Retroperitoneal Fibrosis / Q000175:diagnosis* / Q000276:immunology; D012793:Sialadenitis / Q000175:diagnosis* / Q000276:immunology; D014605:Uveitis / Q000175:diagnosis* / Q000276:immunology
chemical_list: D007074:Immunoglobulin G