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Tumor Discovery Ureteral IgG4-related disease in urology

relatively high complication rate associated with rituximab Funding
therapy significantly limits its applicability in the treatment
of IgG4-associated disease, particularly for maintenance This research received support from the Ministry of Higher
indications. Despite existing recommendations for Education and Science of the Russian Federation through
a grant (No. 075-15-2020-912) for the creation and
treating IgG4-associated disease, many experts advocate
for a cautious approach in specific clinical situations . development of world-class research centers (Photonics
[20]
In our clinical observation, considering the radical nature Center).
of surgical treatment and the absence of disease-related Conflict of interest
clinical manifestations, the decision was made to opt for
dynamic observation. This approach helped minimize the The authors declare that they have no competing interests.
drug burden of the patient and postponed the initiation of Author contributions
drug therapy.
The question of optimal diagnostic methods for Conceptualization: Ekaterina Anikanova, Daniel Yagudaev
actively monitoring patients after treatment is still not fully Data curation: Konstantin Firsov
resolved. PET-CT is considered a promising method for Formal analysis: Nina Kalyagina, Arina Plotnikova
the diagnosis and dynamic monitoring of IgG4-associated Investigation: Nina Kalyagina, Daniel Yagudaev
disease. An evaluation of 46 PET-CT scans in 21 patients Methodology: Daniel Yagudaev, Ekaterina Anikanova,
[21]
diagnosed with IgG4-associated disease revealed Konstantin Firsov
pathological accumulation of FDG in organs commonly Resources: Daniel Yagudaev
affected by IgG4-associated disease at the time of diagnosis Supervision: Daniel Yagudaev
or recurrence. Validation: Ekaterina Anikanova, Daniel Yagudaev
Visualization: Konstantin Firsov
In general, PET-CT has demonstrated greater Writing – original draft: Ekaterina Anikanova, Nina
sensitivity than standard imaging in diagnosing lesions Kalyagina
in various organs, particularly in arteries, salivary glands, Writing – review & editing: Daniel Yagudaev, Arina
and lymph nodes. However, in certain cases (e.g., in the Plotnikova
presence of small lesions), false-negative results were
observed. PET-CT findings before and after treatment Ethics approval and consent to participate
generally correlated with the response to therapy and The study was conducted according to the guidelines of the
disease activity.
Declaration of Helsinki. Ethical review and approval were
In presenting this clinical observation, our objective is waived for this study due to the retrospective nature of the
to raise awareness among urologists regarding the potential study and the use of de-identified data.
presence of IgG4-RD in patients with suspected urothelial
carcinoma of the ureter. We propose incorporating the Consent for publication
determination of serum IgG4 and, in specific cases, biopsy Informed consent was obtained from the patient involved
of the formation into the diagnostic algorithm. in the study.

4. Conclusion Availability of data
This uniquely rare clinical case emphasizes the importance All information that grounded this case report is available
for urologists to consider IgG4-RD in the differential within the main text, tables, and figures. Further data are
diagnosis of ureteral neoplasms. Given that IgG4-RDs available from the corresponding author upon request.
can be manifested in various organs and often resemble
malignant neoplasms, we advocate for the inclusion of References
serum IgG4 level determination in the diagnostic algorithm 1. Maritati F, Peyronel F, Vaglio A, 2020, IgG4-related disease:
for such polysemantic clinical scenarios. Accurate and A clinical perspective. Rheumatology (Oxford), 59(Suppl 3):
timely recognition of IgG4-RD of the ureter facilitates a iii123–iii131.
conservative cure with GSC drugs, potentially averting the
need for aggressive surgical treatment. https://doi.org/10.1093/rheumatology/kez667
2. Zhang W, Stone JH, 2019, Management of IgG4-related
Acknowledgments disease. Lancet Rheumatol, 1: e55–e65.
None. https://doi.org/10.1016/S2665-9913(19)30017-7

Volume 2 Issue 3 (2023) 6 https://doi.org/10.36922/td.1766