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Immunoglobulin G4-positive lymphoplasmacytic infiltration in a sarcoidal eyelid mass
Hyera Kang1,2, Yasuhiro Takahashi1, Emiko Takahashi3
1a Department of Ophthalmology , Aichi Medical University , Nagakute , Aichi , Japan.
Insights
A rare case of IgG4-related disease presenting as an eyelid mass was diagnosed. The mass resolved without treatment after surgical removal, indicating potential for spontaneous remission in some IgG4-related ophthalmic conditions.
Area of Science:
- Ophthalmology
- Immunology
- Pathology
Background:
- Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that can affect various organs.
- Ophthalmic manifestations of IgG4-RD are uncommon but can present as orbital or eyelid masses.
Observation:
- A 62-year-old woman developed a hard, nonmobile subcutaneous mass on her right nasojugal fold over one month.
- Elevated serum immunoglobulin G4 levels were detected.
- Histopathology revealed IgG4-positive lymphoplasmacytic infiltration, storiform fibrosis, vein occlusion, and necrotizing epithelioid granulomas.
Findings:
- The patient's presentation and biopsy findings were consistent with IgG4-related disease.
- Systemic review suggested concurrent sarcoidosis.
- The eyelid mass did not recur six months post-excision without further treatment.
Implications:
- This case highlights IgG4-RD as a differential diagnosis for eyelid masses.
- The findings suggest that some IgG4-related ophthalmic lesions may exhibit spontaneous remission or regression after biopsy.
- Further research is needed to understand the natural history and optimal management of IgG4-RD in the ophthalmic region.
Abstract:
A 62-year-old woman presented with a one month history of a hard, nonmobile subcutaneous mass along the right nasojugal fold. Hematological studies showed elevated serum immunoglobulin G4 levels. Histopathological examination of the biopsy sample disclosed immunoglobulin G4-positive lymphoplasmacytic infiltration with a storiform fibrosis, vein occlusion, and epithelioid granulomas with necrosis. Systemic review corresponded to a sarcoidosis. Without treatment, the eyelid mass did not recur six months after the excisional biopsy.
