以颌下腺首发且合并前列腺癌的系统性免疫球蛋白G4相关性疾病病变1例并文献复习  

Systemic immunoglobulin G4-related disease lesions with primary submandibular gland with prostate cancer:A case report and literature review

作　　者：魏文静 刘秋雨 孙建平 张诗涵 程龙龙 王永功 WEI Wenjing;LIU Qiuyu;SUN Jianping;ZHANG Shihan;CHENG Longlong;WANG Yonggong(School of Stomatology,Henan University,Kaifeng Henan 475000;Department of Oral and Maxillofacial Surgery,Henan University People’s Hospital,Zhengzhou 450003;Department of Pathology,Henan University People’s Hospital,Zhengzhou 450003;Department of Pathology,Zhengzhou Yihe Hospital,Zhengzhou 450000,China)

机构地区：[1]河南大学口腔医学院,河南开封475000 [2]河南大学人民医院口腔颌面外科,郑州450003 [3]河南大学人民医院病理科,郑州450003 [4]郑州颐和医院病理科,郑州450000

出　　处：《临床与病理杂志》2023年第4期842-848,共7页Journal of Clinical and Pathological Research

基　　金：国家科技部重点研发计划(2018YFC0114505)。

摘　　要：对1例合并前列腺癌的系统性免疫球蛋白G4相关性疾病(immunoglobulin G4-related disease,IgG4-RD)病变颌下腺组织、前列腺组织进行临床病理特征分析,并复习相关文献。患者男性,67岁,双侧颌下肿大8个月,尿频、尿痛、排尿困难15 d。超声显示双侧颌下腺及全身浅表淋巴结肿大,前列腺回声不均匀。血清学检查发现IgG4、IgG、总前列腺特异抗原、游离前列腺特异抗原水平及血清肿瘤相关物质检测水平升高。镜下颌下腺组织表现为腺泡萎缩,间质纤维组织增生,伴大量淋巴细胞及浆细胞浸润。前列腺癌组织由弥漫浸润的腺体组成,部分腺体形成桑葚样结构,核仁明显,癌组织间质及周围区正常前列腺组织内大量淋巴浆细胞浸润,局灶可见闭塞性静脉炎,伴广泛纤维组织增生。免疫组织化学显示颌下腺及前列腺组织内弥漫IgG、IgG4阳性着色,前列腺癌组织P504S弥漫细胞质阳性。以颌下腺首发且合并前列腺癌的系统性IgG4-RD病变罕见,大量浸润的淋巴浆细胞及间质纤维化对病理诊断有提示作用。当血清IgG4水平升高时,不仅要注意IgG4-RD的诊断及鉴别诊断,也要注意恶性肿瘤的筛查,肿瘤标志物检测及受累器官病理学检查是非常有必要的。Clinicopathological characteristics of submandibular gland and prostate tissues of a case of systemic immunoglobulin G4-related disease(IgG4-RD)with prostate cancer were analyzed,and the related literature was reviewed.The patient was a 67-year-old man with bilateral submaxillary enlargement for 8 months and frequent urination,pain,and dysuria for 15 days.Ultrasound showed bilateral submandibular glands and generalized superficial lymph node enlargement with uneven echo in the prostate.Serological examination found that the serum levels of IgG4,IgG,total prostate specific antigen,free prostate specific antigen,and tumor-related substances were increased.Microscopically,the submandibular gland tissue showed acinar atrophy,hyperplasia of interstitial fiber tissue,infiltration of a large number of lymphocytes and plasma cells.The prostate cancer tissue was composed of diffuse infiltrating glands,some of which formed mulberry-like structures with obvious nucleoli.A large number of lymphoplasmacytic cells were infiltrated in the interstitium of the cancer tissue and the normal prostate tissue in the surrounding area.Immunohistochemistry showed that the submandibular gland and prostate tissues were diffuse IgG and IgG4 positive staining,and P504S was diffuse cytoplasmic positive in prostate cancer tissues.Systemic IgG4-related lesions with initial submandibular gland and prostate cancer are rare.The large number of infiltrating lymphoplasmacytic cells and interstitial fibrosis may be helpful for pathological diagnosis.When the serum IgG4 level increases,we should not only pay attention to the diagnosis and differential diagnosis of IgG4-RD,but also pay attention to the screening of malignant tumors.The detection of tumor markers and pathological examination of the affected organs are very necessary.

关 键 词：免疫球蛋白G4 免疫球蛋白G4相关性疾病 颌下腺炎 前列腺炎 前列腺癌 

分 类 号：R593.2[医药卫生—内科学]