The Journal of Laryngology & Otology

Clinical Records

Immunoglobulin G4 related systemic sclerosing disease involving the temporal bone

L Mastersona1, M Martinez Del Peroa1, N Donnellya2 c1, D A Moffata2 and E Rytinaa3

a1 Department of Otolaryngology, Norfolk and Norwich University Hospital, UK

a2 Department of Skull Base Surgery, Cambridge University Hospital, UK

a3 Department of Histopathology, Cambridge University Hospital, UK

Abstract

Objective: To report a rare condition affecting the temporal bone. Immunoglobulin G4 related systemic sclerosing disease is a recently described autoimmune condition with manifestations typically involving the pancreas, biliary system, salivary glands, lungs, kidneys and prostate. Histologically, it is characterised by T-cell infiltration, fibrosis and numerous immunoglobulin G4-positive plasma cells. This condition previously fell under the umbrella diagnosis of inflammatory pseudotumour and inflammatory myofibroblastic tumour.

Case report: We present the case of a 58-year-old woman with multiple inflammatory masses involving the pharynx, gall bladder, lungs, pelvis, omentum, eyes and left temporal bone, over a seven-year period. We describe this patient's unusual clinical course and pathological features, which resulted in a change of diagnosis from metastatic inflammatory myofibroblastic tumour to immunoglobulin G4 related systemic sclerosing disease. We also review the literature regarding the management of inflammatory pseudotumours of the temporal bone, and how this differs from the management of immunoglobulin G4 related systemic sclerosing disease.

Conclusion: We would recommend a full review of all histological specimens in patients with a diagnosis of temporal bone inflammatory pseudotumour or inflammatory myofibroblastic tumour. Consideration should be given to immunohistochemical analysis for anaplastic lymphoma kinase and immunoglobulin G4, with measurement of serum levels of the latter. Management of the condition is medical, with corticosteroids and immunosuppression, rather than surgical excision.

(Accepted February 22 2010)

(Online publication June 02 2010)

Correspondence:

c1 Address for correspondence: Mr Neil Donnelly, Department of Skull Base Surgery, Cambridge University Hospitals, Hills Road, Cambridge CB2 0QQ, UK. E-mail: neil.donnelly@addenbrookes.nhs.uk

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