PMC7522571_01
Contrasted Abdominal CAT Scan. Nodular wall thickening (white arrows) at the gastro-esophageal junction in a transverse view (A) and coronal view (B).
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Five months later, in May of 2017, given the symptoms, a contrasted abdominal CAT scan was performed showing a nodular infiltrative wall thickening of the gastro-esophageal junction without adenopathy (Fig. 1A-B).
Pre-Operatively Esophageal Motility Test (Cinedeglution). Narrowing of the esophageal tract with respect to contrast medium (white arrow).
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Additionally, an esophageal motility test (cinedeglution) confirmed a subcardial gastric stenosis (Fig. 2).
Post-Operatively Esophageal Motility Test (Cinedeglution). Adequate passage of the contrast medium through the anastomosis (A) and all the way through to the distal intestine (B).
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During these admissions, an esophageal motility test confirmed adequate passage of medium contrast (Fig. 3A-B), without any filtration or stenosis, ruling out any surgical complications associated with the readmissions.
Post-Operative Histologic Specimens. Inflammatory infiltration of plasmocytic cells on low magnification.
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Given the findings of an IgG4-related inflammatory gastric wall neoplasia, inactive moderate non-atrophic chronic gastritis, focal intestinal metaplasia without dysplasia (Fig. 4, Fig. 5, Fig. 6), and normal spleen, the consideration of an IgG4-related disease had to be considered.
Post-Operative Histologic Specimens. Immunohistochemical markers for IgG4, positive cells stain brown color.
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Given the findings of an IgG4-related inflammatory gastric wall neoplasia, inactive moderate non-atrophic chronic gastritis, focal intestinal metaplasia without dysplasia (Fig. 4, Fig. 5, Fig. 6), and normal spleen, the consideration of an IgG4-related disease had to be considered.