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(a), (b) CECT showing a 3-cm hypervascular tumor (arrow) in the ileocecal region accompanied by small bowel obstruction.
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Contrast-enhanced computed tomography (CECT) showed a 3-cm hypervascular tumor in the ileocecal region, revealing small bowel obstruction (Figure 1).
(a) MRI T2-weighted images showing mild high intensity lesions in the ileocecal region (arrow). (b) MRI diffusion-weighted images showing decreased diffusion in lesions (arrow).
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The lesion emitted slightly high intensity on simple magnetic resonance imaging (MRI) T2-weighted images and showed decreased diffusion on diffusion-weighted images (DWI) (Figure 2).
Contrast imaging of the ileus tube showing extrinsic compression of the ileocecal region (arrow). TI: terminal ileum, C: cecum, A: Ascending colon.
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Contrast imaging of the ileus tube showed extrinsic compression of the ileocecal region (Figure 3).
(a) Endoscopy of the lower gastrointestinal tract showing no abnormalities in the mucous membrane of the cecum and ileum. (b) Extramural compression was detected in the terminal ileum (arrow).
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While endoscopy of the lower gastrointestinal tract revealed no abnormalities in the mucous membrane of the ileum and cecum, the terminal ileum exhibited extramural compression (Figure 4).
(a) Forward-viewing linear echoendoscope, TGF-UC180J (Olympus Medical Systems Corp, Tokyo, Japan). (b) EUS revealed an irregular hypoechoic tumor measuring 3 cm outside the gastrointestinal tract.
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(a) A specimen obtained by EUS-FNA. Pathologically, the lesion was found to be composed of inflammatory fibrous tissues with lymphoplasmacytic infiltration (Hematoxylin-Eosin Stain, x400). (b) IgG4 staining revealed more than 10 IgG4-positive cells in an HPF (IgG4 Stain x400).
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Pathologically, the lesion was found to comprise inflammatory fibrous tissues with lymphoplasmacytic infiltration, and more than 10 IgG4-positive cells were detected in a high-power field (HPF) (Figure 6).
(a) Contrast-enhanced MRI showing an irregular tumor in the left maxillary sinus (arrow). (b) Pathologically, diffuse lymphoplasmacytic infiltration and storiform fibrosis are observed (Hematoxylin-Eosin Stain, x200). (c) More than 50 IgG4-positive cells are observed in an HPF (IgG4 Stain, x400).
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Contrast-enhanced MRI revealed an irregular tumor showing contrast in the left maxillary sinus (Figure 7). IgG4-positive cells in an HPF, which was consistent with IgG4-RD (Figure 7). IgG staining was difficult because it involved co-staining.
(a) CECT showing complete disappearance of the tumor at 2 months after steroid treatment (arrow). (b) MRI diffusion-weighted images indicate the absence of any lesion (arrow).
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CT and MRI performed 2 months later showed complete disappearance of the ileocecal tumor (Figure 8).