PMC6277136_01
Abdominal and pelvic axial computed tomography (CT) with contrast showing the cecal mass (arrow) causing obstruction and multiple fluid-filled small bowel loops.
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F1
On imaging, multiple air-fluid levels consistent with obstruction and a 6.1-cm ileocecal mass with adjacent pericolonic lymph nodes measuring up to 2 cm were identified (Figure 1).
Hematoxylin and eosin staining of terminal ileum showing (A) lymphoid infiltration and fibrosis in the subserosa and (B) storiform pattern of fibrosis in the subserosa.
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F2
Histologic sections from the mass showed lymphoplasmacytic infiltrates with scattered eosinophils and storiform fibrosis in the subserosa extending into the submucosa (Figure 2).
Immunohistochemical staining showing IgG4-positive plasma cells.
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F3
Immunohistochemistry staining revealed an increased IgG4/IgG ratio with up to 60 IgG4-positive plasma cells per high-power field (Figure 3).