Immunoglobulin G4 related mastitis: A case report

Abstract

Immunoglobulin (Ig)G4-related sclerosing disease is a recently recognised condition characterised by mass forming lesions associated with storiform fibrosis, obliterative phlebitis, lymphoplasmacytic infiltrate rich in IgG4 positive plasma cells and elevated serum IgG4 levels. IgG4-related mastitis (IgG4-RM) is exceedingly rare with only thirteen cases reported in the literature to date. Immunoglobulin G4-RM is diagnosed exclusively on histological analysis. It is a benign chronic inflammatory process that can be treated sufficiently with excision or steroid. However, conservative treatment should be preferred and unnecessary surgery should be avoided as IgG4-RM respond to simple and effective steroid treatment. Herein, we presented a 28-year-old patient with IgG4-RM. She was the youngest patient in the literature at the time of her diagnosis

Keywords

• Mastitis,IgG4,Steroid therapy,Inflammatory pseudotumour

References

1. [1] Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995;40:1561-8. doi:10.1007/ bf02285209
2. [2] Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med 2001;344:732-8.
3. [3] Stone J, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med 2012;366:539-51. doi: 10.1056/NEJMra1104650
4. [4] Yokoe T, Hayashida T, Kikuchi M, et al. IgG4-related mastopathy: A case report and literature review. Clin Case Rep 2018;6:1549-53. doi: 10.1002/ccr3.1657
5. [5] Cheuk W, Chan AC, Lam WL, et al. IgG4-related sclerosing mastitis: description of a new member of the IgG4-related sclerosing diseases. Am J Surg Pathol 2009;33:1058-64. doi: 10.1097/PAS.0b013e3181998cbe
6. [6] Zen Y, Kasahara Y, Horita K, et al. Inflammatory pseudotumor of the breast in a patient with a high serum IgG4 level: histologic similarity to sclerosing pancreatitis. Am J Surg Pathol 2005;29:275-8. doi:10.1097/01.pas.000.014.7399.10639.
7. [7] Ogiya A, Tanaka K, Tadokoro Y, et al. IgG4-related sclerosing disease of the breast successfully treated by steroid therapy. Breast Cancer 2014;21:231-5. doi: 10.1007/s12282.010.0225-6
8. [8] Chougule A, Bal A, Das A, Singh G. IgG4 related sclerosing mastitis: expanding the morphological spectrum of IgG4 related diseases. Pathology 2015;47:27-33. doi: 10.1097/ PAT.000.000.0000000187

9. [9] Moriya TH, Nagashima H, Yasuda M, Kimijima I. IgG4related disease of the breast: a systemic disease whose mammary manifestations mimic breast cancer. Int Cancer Conf J 2015;4:67-72. doi: 10.1007/s13691.015.0209-7
10. [10] Tan ES, Friesen B, Loh SF, Fox J. Immunoglobulin-G4 related mastitis: a case report. Int J Surg Case Rep 2017;37:169-72. doi: 10.1016/j.ijscr.2017.06.012
11. [11] Vitkovski T, Marder GS, Filardi DA, Gupta E, Breuer F. IgG4related sclerosing disease of the breast in a male patient. Int J Surg Pathol. 2017;25:711-5. doi: 10.1177/106.689.6917714324.
12. [12] Deshpande V, Zen Y, Chan J, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol 2012;25:118192.doi: 10.1038/modpathol.2012.72