title: IgG4-related disease of the paratestis in a patient with Wells syndrome: a case report.
abstract: BACKGROUND
  We report a case of a 33-year-old man who presented with immunoglobulin (Ig)G4-related disease (IgG4-RD) forming a pseudotumor in the left paratesticular region during oral administration of corticosteroid for Wells syndrome, which involves cellulitis with eosinophilia.
  
  
  METHODS
  The patient was introduced to our institution from a private hospital with a 3-month history of asymptomatic left scrotal mass. A 5-cm diameter nodule was palpable in the left scrotum. Tumor lesion in the left paratestis involving the epididymis and spermatic cord was observed on computed tomography and magnetic resonance imaging. Blood testing showed no abnormalities other than a minimal increase in C-reactive protein levels. Urine examination likewise revealed no significant findings. Left radical orchidectomy was performed under a diagnosis of left paratesticular neoplasm suspected as malignant tumor. The tumor was pathologically identified as IgG4-RD of the left paratestis involving the epididymis and spermatic cord.
  
  
  CONCLUSIONS
  We present a first description of IgG4-RD in a patient with Wells syndrome and the ninth case of IgG4-RD in a scrotal organ, and discuss this very rare entity with reference to the literature.
  The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_225.
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. karasima@kochi-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Karashima
authors.affiliation: Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Nankoku, 783-8505, Japan. taniguchiy@kochi-u.ac.jp.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Taniguchi
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. jm-tshimamoto@kochi-u.ac.jp.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Shimamoto
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. jm-naotomo@kochi-u.ac.jp.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Nao
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. drhiroshi67@extra.ocn.ne.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishikawa
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. jm-fukatas@kochi-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fukata
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. kamadam@kochi-u.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kamada
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. keiji@kochi-u.ac.jp.
authors.forename: Keiji
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Dermatology, Kochi Medical School, Nankoku, 783-8505, Japan. kentaro-ohko@kochi-u.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Oko
authors.affiliation: Department of Dermatology, Kochi Medical School, Nankoku, 783-8505, Japan. nakajima@kochi-u.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Dermatology, Kochi Medical School, Nankoku, 783-8505, Japan. sano.derma@kochi-u.ac.jp.
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Sano
authors.affiliation: Laboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, 783-8505, Japan. manabu_matumoto@khsc.or.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Department of Diagnostic Pathology, Kochi Red Cross Hospital, Kochi, 780-0062, Japan. kurochankochi@yahoo.co.jp.
authors.forename: Naoto
authors.initials: N
authors.lastname: Kuroda
authors.affiliation: Kamei Private Clinic, Kochi, 780-0085, Japan. kame.arist8634@docomo.ne.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kamei
authors.affiliation: Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan. shuint@kochi-u.ac.jp.
authors.forename: Taro
authors.initials: T
authors.lastname: Shuin
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery; D015415:Biomarkers / Q000032:analysis; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D003951:Diagnostic Errors; D004802:Eosinophilia / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006104:Granuloma, Plasma Cell / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D009919:Orchiectomy; D011237:Predictive Value of Tests; D013733:Testicular Diseases / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery; D013736:Testicular Neoplasms / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D007074:Immunoglobulin G