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Immunoglobulin G4 related systemic sclerosing disease involving the temporal bone

Published online by Cambridge University Press:  02 June 2010

L Masterson ,
M Martinez Del Pero ,
N Donnelly ,
D A Moffat  and
E Rytina
L Masterson
Affiliation:
Department of Otolaryngology, Norfolk and Norwich University Hospital, UK
M Martinez Del Pero
Affiliation:
Department of Otolaryngology, Norfolk and Norwich University Hospital, UK
N Donnelly*
Affiliation:
Department of Skull Base Surgery, Cambridge University Hospital, UK
D A Moffat
Affiliation:
Department of Skull Base Surgery, Cambridge University Hospital, UK
E Rytina
Affiliation:
Department of Histopathology, Cambridge University Hospital, UK
*
Address for correspondence: Mr Neil Donnelly, Department of Skull Base Surgery, Cambridge University Hospitals, Hills Road, Cambridge CB2 0QQ, UK. E-mail: [email protected]
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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.

Keywords

Temporal BoneIgG4Inflammatory Pseudotumor
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 10 , October 2010 , pp. 1106 - 1110
Copyright
Copyright © JLO (1984) Limited 2010

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