Authors
Dong Hu, Wei Rong, Fei Song, Songhua Xiao
Published in
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Jul 06, 2026. Epub Jul 06, 2026.
Abstract
IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder characterized by tumefactive lesions, dense infiltration of IgG4-positive plasma cells, and variable organ involvement. Inflammatory pseudotumors associated with IgG4-RD are uncommon, and spinal nerve root involvement is exceedingly rare. Such lesions may closely mimic malignant spinal tumors on imaging, posing significant diagnostic challenges.
We report the case of a 55-year-old woman who presented with progressive lower back pain and urinary incontinence. Magnetic resonance imaging revealed a space-occupying lesion in the left L1/2 intervertebral foramen. ^18F-FDG positron emission tomography-computed tomography (PET-CT) demonstrated intense focal hypermetabolism with a markedly elevated maximum standardized uptake value (SUVmax) of 11.95, strongly suggesting a malignant process. The patient underwent surgical decompression and tumor resection. Histopathological examination revealed a fibroinflammatory lesion with dense lymphoplasmacytic infiltration and abundant IgG4-positive plasma cells (45/HPF in hotspots), consistent with an IgG4-related inflammatory pseudotumor, despite normal serum IgG4 levels.
This case highlights that, despite strong radiological suspicion for malignancy, preoperative biopsy may allow diagnosis of IgG4-RD and enable corticosteroid therapy, potentially avoiding unnecessary radical surgery.
PMID:
42406076
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.
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