title: A case of IgG4-related disease coexisted with rectal cancer.
abstract: A 67-year-old man was referred to our hospital with suspicion of rectal tumor, hilar tumor, and urinary tumor. Colonoscopic findings were intermittent nodular lesions with redness which were atypical to primary rectal cancer. Endoscopic retrograde cholangiopancreatography showed narrowing of the bilateral intrahepatic bile duct. However, the findings were improved 1 month later. Blood biochemistry showed high level of serum IgG4 up to 1140 mg/dl. The patient matched to comprehensive diagnostic criteria for IgG4-related disease as a possible diagnostic case. Laparoscopic low anterior resection with creation of ileostomy was performed for rectal cancer. Histological findings revealed cancer cells spread horizontally at submucosal layer and subserosal layer. There was marked infiltration of the plasma cells and lymphocytes at tumor stroma, and more than half of the plasma cells were positive for IgG4. After surgery, the level of serum IgG4 was decreased to 597 mg/dl. Although the association with IgG4-related disease and colorectal disease is unclear, the tumor progression was atypical for rectal cancer. Some report that the disease may rise up the risk of a malignant disease. It is necessary to perform systemic examination keeping in mind for concurrence of malignancy.
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. tk-tsuchiya@muh.biglobe.ne.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsuchiya
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. mob_p_q_dom@yahoo.co.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yagi
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. psxrrfsgi@i.softbank.jp.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Tsukamoto
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. yoshihisafukushima1209@yahoo.co.jp.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fukushima
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. ryu@med.teikyo-u.ac.jp.
authors.forename: Ryu
authors.initials: R
authors.lastname: Shimada
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. doctor.k.227@hotmail.co.jp.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. sfujii631011@med.teikyo-u.ac.jp.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Fujii
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. knozawa@med.teikyo-u.ac.jp.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Nozawa
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. keiji@med.teikyo-u.ac.jp.
authors.forename: Keiji
authors.initials: K
authors.lastname: Matsuda
authors.affiliation: The Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. ykikuchi@med.teikyo-u.ac.jp.
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: The Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. ksaito@med.teikyo-u.ac.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Saito
authors.affiliation: The Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan. yhashi@med.teikyo-u.ac.jp.
authors.forename: Yojiro
authors.initials: Y
authors.lastname: Hashiguchi
keywords: IgG4-related disease; Rectal cancer; Sclerosing cholangitis