Chronic gastric ulceration: a novel manifestation of IgG4-related disease?
- 1Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- 2University Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Correspondence to Dr Adrian C Bateman, Department of Cellular Pathology, MP002, Level E, South Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; adrian.bateman{at}uhs.nhs.uk
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Contributors ACB is the consultant histopathologist who made the diagnosis of IgG4-related disease and who wrote the first draft of the manuscript. MS is the registrar in histopathology who dissected the case, arranged all of the additional stains and commented on the draft manuscript. TJU is the senior lecturer in surgery who performed the operation, obtained consent from the patient and commented on the draft manuscript, including confirming the accuracy of the clinical information.
- Gastric
- immunoglobulin
- immunohistochemistry
- autoimmunity
- gut pathology
- autopsy pathology
- breast
- pancreas
- liver disease
- GI neoplasms
- oesophagus
- P53
- tumour cell culture
- tumour biology
Case report
A 73-year-old woman who presented with anaemia and gastroscopy revealed a 30 mm firm ulcer with raised edges at the lesser curve of the stomach. A CT scan revealed features within the ulcer that were suspicious for malignancy. She was treated with a proton pump inhibitor and sucralfate but the ulcer failed to heal over a 1-year period. Three sets of biopsies from the ulcer edge during this time revealed benign changes only. There was no history of non-steroidal anti-inflammatory drug usage and urinary salicylate estimation was negative. The serum gastrin concentration was not raised. Her medical history included insulin-dependent diabetes mellitus and ischaemic heart disease. There was no history of a systemic inflammatory disorder. Due to the continued concern of occult malignancy she proceeded to laparotomy with partial gastrectomy, after which she made an uneventful recovery.
Macroscopic examination of the resection specimen revealed a 30 mm mucosal ulcer with slightly raised edges. The adjacent gastric mucosa was macroscopically normal. …
