Resection of lesions in the ileum of patients with IgG4-related disease may ameliorate disease progression without steroid administration.

BACKGROUND: IgG4-related disease (IgG4-RD) is a pathological condition that is characterized by an infiltrate composed of IgG4-positive plasma cells and recently recognized as an immune-mediated condition. It causes tissue throughout the body to become stiff and thickened due to autoimmune reactions that cause fibrosis and scarring. Disease-related changes commonly occur in the salivary glands, bile duct, pancreas, and lungs, but are seldom seen in the small bowel. A diagnosis of IgG4-RD is suspected if a high level of IgG4 is found on a blood test. The ideal diagnostic method is pathological examination, but because the clinical manifestations of IgG4-RD are very diverse and nonspecific, the disease may often go undiagnosed until an unrelated biopsy or resection specimen is obtained. The most common treatment for IgG4-RD is steroid use. However, tapering or stopping steroid administration is seen to result in recurrence in approximately 50% of cases. A complete cure is therefore considered extremely difficult. CASE PRESENTATION: A 69-year-old man with gastrointestinal obstruction underwent small bowel resection for two lesions. On histopathological examination, the specimen showed features of IgG4-RD. We performed several tests to detect other characteristics of IgG4-RD, but were unable to find any. The patient is being followed up regularly for a year and is being observed for any symptoms of recurrence. CONCLUSIONS: We present a case of IgG4-RD wherein the ileum wall was significantly sclerosed, leading to gastrointestinal tract obstruction; therefore, we resected two sections of the ileum. We believe that resection of IgG4-RD lesions can help avoid long-term steroid use in patients, because the surgery completely eliminates the pathological origins of the condition.

[A case of gastric endocrine cell carcinoma with liver metastasis showing rapid growth during pregnancy and marked reduction by systemic chemotherapy after delivery].

A 28-year-old woman was given a diagnosis of gastric endocrine cell carcinoma with multiple liver metastases in 1997. Chemotherapy was administered for treatment after a distal gastrectomy and hepatic tumor resection, and she had shown no sign of relapse after 2002. In February 2004, she was in the third month of pregnancy, and experienced recurrent liver metastasis. Although the tumor grew rapidly from 3cm to 10cm during her pregnancy, its size was significantly reduced with systemic chemotherapy after delivery. This is a rare case in which a liver metastasis of a gastric endocrine cell carcinoma grew during the course of pregnancy.

Intraoperative fluoroscopic detection of an occult jejunal arteriovenous malformation.

A case of chronic gastrointestinal hemorrhage caused by a small jejunal arteriovenous malformation is presented. After microcatheter and microcoil placement, the patient underwent laparoscopically assisted jejunal resection. Intraoperative localization was accomplished by combined use of methylene blue injection and contrast medium injection. Methylene blue injection demarcated the segment of bowel involved and fluoroscopy by contrast medium injection revealed the arteriovenous malformation. This technique located the arteriovenous malformation during surgery and insured adequate but not excessive bowel resection.