Abstract
The case involved a 66-year-old man who underwent esophagogastroduodenoscopy for epigastralgia 4 years earlier that revealed erosion and a small bulge at the greater curvature of the upper body of the stomach. The patient had been followed because a biopsy revealed the bulge to be classified into the Group 2. In addition, he had been treated with oral steroid preparation with the diagnosis of Mikulicz disease on an ambulant basis since about 2 years previously. A recent follow-up esophagogastroduodenoscopy revealed that mucosal irregularity became evident and the bulge enlarged, and a biopsy showed well differentiated adenocarcinoma. The patient was then referred to our department. A CT scan showed remarkable wall thickening of the lesion and swollen lymph nodes, so that exploratory laparotomy was performed with a suspicion of scirrhus gastric cancer. It disclosed an atypical small nodule in the vicinity of the lesion. After conducting neoadjuvant chemotherapy with two courses of S-1+CDDP, we performed total gastrectomy, associated splenectomy and D2 lymph node dissection. The histopathological diagnosis of the swollen and sclerotic lymph node was IgG4-related lymphadenopathy. We have great difficulties in diagnosing the progression of gastric cancer if it is associated with IgG4-relating disease. So we have to decide therapeutic guidelines by keeping the possibility in mind that the gastric wall thickening and lymph node swelling might result from the IgG4-relating disease in the treatment of such patients.
