METHODS: A 72-year-old Japanese man had been treated by a nearby doctor for hypertension, but subsequently developed lower urinary tract symptoms and was prescribed an α1 blocker for 1 year. However, the patient was subsequently referred to our department because his symptoms did not improve. Prostate-specific antigen was 1.258 ng/ml; however, the nodule was palpable in the right lobe on digital rectal examination, and magnetic resonance imaging suggested Prostate Imaging and Reporting and Data System category 3. Therefore, transrectal prostate needle biopsy (12 locations) under ultrasound was performed. Histopathological examination revealed no malignant findings, although infiltration of lymphocytes and plasma cells, and partial fibrosis were observed. No remarkable findings of obstructive phlebitis were observed. Immunoglobulin G4-related disease was suspected, and immunoglobulin and immunoglobulin G4 immunostaining was performed. Immunoglobulin G4 positive plasma cells were observed in a wide range, immunoglobulin G4 positive cells were noted at > 10 per high-power field, and the immunoglobulin G4 positive/immunoglobulin G positive cell ratio was > 40%. Serum immunoglobulin G4 levels were high at 1600 mg/dl. Enhanced abdominal computed tomography findings suggested periaortitis. Additionally, multiple lymphadenopathies were observed around the abdominal aorta. The patient was accordingly diagnosed with immunoglobulin G4-related disease definite, diagnosis group (definite). We proposed steroid treatment for periaortic soft tissue lesions and lower urinary tract symptoms; however, the patient was refused treatment. A computed tomography scan 6 months after diagnosis revealed no changes in the soft tissue lesions around the aorta. Follow-up computed tomography examinations will be performed every 6 months.
CONCLUSIONS: If immunoglobulin G4-related disease is suspected and a highly invasive examination is required for histopathological diagnosis, this can be performed by a relatively minimally invasive prostate biopsy for patients with lower urinary tract symptoms. Further evidence is needed to choose an optimal candidate for prostate biopsy for lower urinary tract symptoms patients with suspicion of immunoglobulin G4-related disease. For patients with lower urinary tract symptoms with immunoglobulin G4-related disease or a history, performing a prostate biopsy may avoid unnecessary treatment. However, if steroid therapy is ineffective, surgical treatment should be considered.
方法:一名72岁的日本男子因高血压接受了附近医生的治疗,但随后出现下尿路症状,并服用α1阻断剂1年。然而,该患者随后被转诊到我们部门,因为他的症状没有改善。前列腺特异性抗原为1.258ng/ml;然而,直肠指检可见右叶结节,和磁共振成像建议前列腺成像和报告和数据系统类别3。因此,在超声下进行经直肠前列腺穿刺活检(12个位置)。组织病理学检查未发现恶性病变,虽然淋巴细胞和浆细胞浸润,观察到部分纤维化。未观察到阻塞性静脉炎的显着发现。怀疑免疫球蛋白G4相关疾病,进行免疫球蛋白和免疫球蛋白G4免疫染色。免疫球蛋白G4阳性浆细胞在广泛的范围内观察到,免疫球蛋白G4阳性细胞在每个高倍视野>10,免疫球蛋白G4阳性/免疫球蛋白G阳性细胞比例>40%。血清免疫球蛋白G4水平高达1600mg/dl。增强的腹部计算机断层扫描结果提示主动脉周围炎。此外,在腹主动脉周围观察到多发性淋巴结病。患者明确诊断为免疫球蛋白G4相关疾病,诊断组(明确)。我们建议对主动脉周围软组织病变和下尿路症状进行类固醇治疗;然而,患者被拒绝治疗。诊断后6个月的计算机断层扫描显示,主动脉周围的软组织病变没有变化。每6个月进行一次后续计算机断层扫描检查。
结论:如果怀疑免疫球蛋白G4相关疾病,并且需要进行高侵入性检查以进行组织病理学诊断,对于有下尿路症状的患者,可以通过相对微创的前列腺活检来进行。对于怀疑免疫球蛋白G4相关疾病的下尿路症状患者,需要进一步的证据来选择前列腺活检的最佳候选者。对于患有免疫球蛋白G4相关疾病或有病史的下尿路症状的患者,进行前列腺活检可以避免不必要的治疗.然而,如果类固醇治疗无效,应考虑手术治疗。