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中华消化病与影像杂志(电子版) ›› 2025, Vol. 15 ›› Issue (06) : 676 -680. doi: 10.3877/cma.j.issn.2095-2015.2025.06.020

临床病例分析

内镜黏膜下剥离术治疗以黏膜下隆起为表现的IgG4相关性胃病一例
戴婧1, 林敏1, 胡迎春2,()   
  1. 1213000 江苏常州,南京医科大学第三附属医院消化内科
    2213000 江苏省,常州市新北区奔牛人民医院内镜中心
  • 收稿日期:2025-08-19 出版日期:2025-12-01
  • 通信作者: 胡迎春
  • 基金资助:
    常州市十四五高层次人才项目(2022CZBJ052)

Endoscopic submucosal dissection for IgG4-related gastric disease presenting with submucosal elevation: a case report

Jing Dai1, Min Lin1, Yingchun Hu2,()   

  1. 1Department of Gastroenterology, Third Affiliated Hospital of Nanjing Medical University, Changzhou 213000, China
    2Endoscopy Center, Benniu People's Hospital of Xinbei District of Changzhou, Changzhou 213000, China
  • Received:2025-08-19 Published:2025-12-01
  • Corresponding author: Yingchun Hu
引用本文:

戴婧, 林敏, 胡迎春. 内镜黏膜下剥离术治疗以黏膜下隆起为表现的IgG4相关性胃病一例[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(06): 676-680.

Jing Dai, Min Lin, Yingchun Hu. Endoscopic submucosal dissection for IgG4-related gastric disease presenting with submucosal elevation: a case report[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(06): 676-680.

IgG4相关性疾病是一类罕见的自身免疫相关性疾病,可累及多器官,胃部受累相对少见,临床表现和影像学特征常缺乏特异性,易与胃肿瘤、淋巴瘤等混淆,易漏诊、误诊。本文报道了1例IgG4相关性胃病的内镜诊治过程,采用内镜下黏膜剥离术将病变完整切除。

Immunoglobulin G4 (IgG4)-related disease is a rare, systemic autoimmune disorder that can affect multiple organs. Gastric involvement is uncommon and often presents with non-specific clinical and radiological features, posing a diagnostic challenge and frequently leading to misdiagnosis as gastric neoplasms or lymphoma. In this report, we present a case of IgG4-related gastric disease diagnosed and managed with endoscopic submucosal dissection, resulting in complete lesion resection.

图1 上腹部隐痛患者入院检查注:1A白光内镜表现胃底体交界处前壁见一大小约2.0 cm×2.0 cm黏膜隆起,中央可见火山口样溃疡;1B靛胭脂染色下病灶边界清晰,中央凹陷;1C NBI下表现表面微结构、微血管规则,中央结构不清;1D超声(20 MHz)内镜显示低回声病变,起源于黏膜下层,部分黏膜下层结构中断;1E活检病理HE染色示轻度慢性浅表性炎,伴固有层淋巴滤泡样增生;1F腹部CT示胃底体交界处前壁可见低回声病变
图2 内镜下黏膜剥离术注:2A环周切开;2B剥离病灶;2C荷包缝合封闭创面;2D术后标本
图3 术后病理检查结果注:3A HE染色黏膜下纤维组织及淋巴滤泡增生,表面胃黏膜小灶溃疡修复性改变;3B HE染色黏膜下纤维组织增生伴大量淋巴浆细胞浸润;3C HE染色显示闭塞性静脉炎对应的弹力纤维;3D免疫组织化学染色显示CD138见大量浆细胞浸润(×20);3E免疫组织化学染色显示大量IgG阳性浆细胞浸润(×20);3F IgG4阳性浆细胞浸润(×40)
图4 复查胃镜可见内镜下黏膜剥离术后瘢痕形成
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