误诊为IgG4相关性肺病的肺腺癌1例并文献复习  

Lung adenocarcinoma misdiagnosed as IgG4-related lung disease:A case report and literature review

作　　者：龙颖姣 刘晓鹏 赵玉琪 卿洁[1] 张科[3] 彭红[1] LONG Yingjiao;LIU Xiaopeng;ZHAO Yuqi;QING Jie;ZHANG Ke;PENG Hong(Department of Respiratory and Critical Care Medicine,Second Xiangya Hospital,Central South University,Changsha 410011;Department of Critical Care Medicine,Hunan Want Want Hospital,Changsha 410016;Department of Pathology,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院呼吸与危重症医学科,长沙410011 [2]湖南旺旺医院重症医学科,长沙410016 [3]中南大学湘雅二医院病理科,长沙410011

出　　处：《中南大学学报（医学版）》2021年第7期767-773,共7页Journal of Central South University ：Medical Science

基　　金：supported by the National Key Clinical Specialty Construction Project (2012-650);the National Natural Science Foundation (81800043);the Natural Science Foundation of Hunan (2020JJ5818),China

摘　　要：IgG4相关性疾病是一类以血清IgG4水平升高和IgG4阳性浆细胞浸润器官为特征的自身免疫性疾病,然而,该两种特点并无特异性,亦可见于肿瘤和其他结缔组织疾病,因此临床上难以鉴别,容易造成误诊。中南大学湘雅二医院呼吸与危重症医学科收治1例初始误诊为IgG4相关性肺病的患者,该患者因“反复发热、胸痛1个月余”收住院,入院后行相关检查,最初考虑诊断为IgG4相关性肺病,然而糖皮质激素治疗无效,再次活检后确诊为肺腺癌。肺腺癌患者可出现血清IgG4水平升高和IgG4阳性浆细胞浸润,机制尚不明确。因此,在诊断IgG4相关性疾病时,应充分评估症状、血清学指标以及病理结果,避免误诊。IgG4-related disease(IgG4-RD)is a recently recognized disorder characterized by elevated serum IgG4 levels and infiltration of IgG4 positive blood cells in the affected organs.However,other conditions like malignancy as well as connective tissue diseases,may show similar findings.A 56-year-old male patient visited Second Xiangya Hospital,Central South University for recurrent fever and chest pain for more than 1 month.Preliminary tests diagnosed as IgG4-related lung disease(IgG4-RLD).However,the improvement of symptoms was absent after the treatment with methylprednisolone.The patient underwent the second biopsy and the result eventually demonstrated lung adenocarcinoma.The role of IgG4 in the pathogenesis or prognosis for lung adenocarcinoma remains unclear.Therefore,a thorough evaluation of symptoms,test of specific serum markers and eventually pathological confirmation are required to avoid misdiagnosis.

关 键 词：IGG4 相关性疾病 IgG4相关性肺疾病 IGG4 阳性浆细胞 肺腺癌 

分 类 号：R734.2[医药卫生—肿瘤]