Tomoaki Sasaki, MD

Our article about IgG4-related diseases (IgG4-RD) described a very rare presentation in the head and neck, resembling malignant tumor. Mass lesions in the nasal cavity and paranasal sinuses can present difficulty in differential diagnosis. Fortunately, imaging usually plays a more important role in the evaluation of invasion and clinical stage than confirming a specific diagnosis. We have regarded bone marrow infiltration and perineural invasion as findings of advanced stage disease, however, the benign IgG4-RD also can have similar characteristics, raising the difficulty of a diagnostic strategy. Toyoda et al¹ showed a tendency for cranial nerve enlargement in the IgG4-RD.¹ We speculate that some lymphoproliferative diseases such as the IgG4-RD might have an affinity for the cranial nerves.

References

1. Toyoda K, Oba H, Kutomi K, et al. MR imaging of IgG4-related disease in the head and neck and brain. AJNR Am J Neuroradiol 2012;33:2136–39, 10.3174/ajnr.A3147

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Editor's Comment

Since this publication, there have been only 8 reports of additional cases with confirmed IgG4-RD involvement centered in the sinuses or nasal cavity. These expand the age to include adolescent patients¹ and describe the range from isolated² to aggressive features mimicking malignancy,³ reaffirming the need for histopathologic confirmation.

1. Prabhu SM, et al. IgG4-related disease with sinonasal involvement: A case series. Indian J Radiol Imag 2014;24:117–20, 10.4103/0971-3026.134384
2. Morris C, Ng T, Kevin P, et al. Immunoglobulin G4-related disease isolated to the nasal cavity: a rare cause of nasal obstruction. J Laryngol Otol 2015;129 Suppl 1:S57–59, 10.1017/S0022215114001911
3. Lindau RH, Su YB, Kobayashi R, et al. Immunoglobulin G4-related sclerosing disease of the paranasal sinus. Head Neck 2013;35:E321–24, 10.1002/hed.23175