Sclerosing Esophagitis with IgG4-positive Plasma Cell Infiltration

Area of Science:

• Gastroenterology
• Immunology
• Pathology

Background:

• Immunoglobulin G4-related disease (IgG4-RD) is a chronic fibroinflammatory condition that can affect various organs.
• Esophageal involvement in IgG4-RD is uncommon, with most reported cases involving other concurrent organ manifestations.

Observation:

• A 76-year-old woman presented with a 3-year history of progressive dysphagia, which worsened after cervical cancer surgery.
• Endoscopic and imaging studies revealed circumferential esophageal erosion and a thoracic esophageal stricture.
• Histological examination of the resected esophagus showed transmural hyperplasia with abundant IgG4-positive plasma cells and lymphocytes.

Findings:

• The patient was diagnosed with probable IgG4-related disease based on the esophageal findings.
• The esophageal lesions, including stricture and wall thickening, were characterized by inflammatory granulation tissue rich in IgG4-positive plasma cells.

Implications:

• This case highlights the importance of considering IgG4-related disease in the differential diagnosis of esophageal strictures, even in the absence of other organ involvement.
• Recognizing IgG4-related esophageal disease is crucial for appropriate diagnosis and management, potentially preventing complications associated with untreated esophageal strictures.
• Further research is needed to understand the specific mechanisms and prevalence of IgG4-related disease presenting exclusively in the esophagus.