Immunoglobulin G4-related sclerosing disease mimicking invasive tumor in the nasal cavity and paranasal sinuses

Abstract

IgG4RSD affecting the nasal cavity and paranasal sinuses is extremely rare. A 71-year-old man presented with an invasive mass in the nasal cavity and paranasal sinuses that was confirmed by immunostaining to be IgG4RSD. The occurrence of this disease in the nasal cavity and paranasal sinuses can resemble a malignant tumor on diagnostic imaging.

Fig 1.

MR imaging of a mass in the nasal cavity and both maxillary sinuses. A, T1-weighted image shows a mass of intermediate intensity compared with muscle and high-intensity areas in the right maxillary sinus. B, Slight hyperintensity is seen on the T2-weighted image. C, Fat-suppressed T1-weighted image has homogeneous gadolinium contrast enhancement.

Fig 2.

Histopathologic evaluation of the biopsy. A, Hematoxylin-eosin stain reveals lymphoid follicles with a germinal center, among proliferative fibrosis with lymphocyte and plasma cells lacking atypia (original magnification ×25). B, Immunohistopathologic staining for CD138 demonstrates plasma cell infiltration (original magnification ×50). C, Immunostaining demonstrates plasma cell IgG4 expression (original magnification ×50).