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Abstract：
We report a rare yet successful utilisation of anti-CD20 therapy using rituximab for treatment of a case of IgG4-related mastitis proven by clinical, serological, and histopathological evidence. This was affecting a mid-aged female who was referred to the rheumatology clinic by the breast surgeons to help assessing for the possibility of an underlying inflammatory process involving the breast tissue unilaterally. The clinical course was apparently complex with an onset of an induration in the right lateral superior quadrant of the breast with mild discomfort and heaviness sensation. This increased over a course of 2 weeks before presentation to the general surgery clinic. Subsequent investigations confirmed that the case was IgG4-related mastitis and a trial of steroids and disease modifying anti-rheumatic drugs (DMARDs) was partially helpful, but not to a full degree, mandating the utilisation of a more advanced mode of therapy, so rituximab was selected.
CONCLUSIONS: Consider inflammatory conditions including IgG4-related disease in the differential diagnosis of lumps including breast masses.IgG4 disease is a rare condition but can have complex clinical course and significant complications that need a low threshold of suspicion in terms of diagnosis.Occasionally, a repeat study and re-reading of histopathological specimen with appropriate immunostaining can open the way for accurate diagnosis in challenging cases with an unreached diagnosis.
CONCLUSIONS: Consider inflammatory conditions including IgG4-related disease in the differential diagnosis of lumps including breast masses.IgG4 disease is a rare condition but can have complex clinical course and significant complications that need a low threshold of suspicion in terms of diagnosis.Occasionally, a repeat study and re-reading of histopathological specimen with appropriate immunostaining can open the way for accurate diagnosis in challenging cases with an unreached diagnosis.
摘要：
我们报道了使用利妥昔单抗治疗一例罕见但成功的抗CD20治疗IgG4相关性乳腺炎的临床证明，血清学,和组织病理学证据.这影响了一名中年女性，该女性被乳腺外科医生转诊到风湿病诊所，以帮助评估涉及单侧乳腺组织的潜在炎症过程的可能性。临床过程显然很复杂，在乳房的右侧上象限出现硬结，并伴有轻度不适和沉重的感觉。在向普外科诊所就诊之前的2周内，这种情况有所增加。随后的调查证实，该病例是IgG4相关性乳腺炎，类固醇和疾病缓解抗风湿药物（DMARDs）的试验部分有帮助，但不是完全的，强制使用更先进的治疗模式，所以选择了利妥昔单抗。
结论：在包括乳腺肿块在内的肿块的鉴别诊断中，考虑炎性病症，包括IgG4相关疾病。IgG4病是一种罕见的疾病，但可能具有复杂的临床过程和严重的并发症，需要在诊断方面的怀疑阈值较低。偶尔,重复研究和用适当的免疫染色重新读取组织病理学标本,可以为在未诊断的具有挑战性的病例中进行准确诊断开辟道路.
结论：在包括乳腺肿块在内的肿块的鉴别诊断中，考虑炎性病症，包括IgG4相关疾病。IgG4病是一种罕见的疾病，但可能具有复杂的临床过程和严重的并发症，需要在诊断方面的怀疑阈值较低。偶尔,重复研究和用适当的免疫染色重新读取组织病理学标本,可以为在未诊断的具有挑战性的病例中进行准确诊断开辟道路.
