case_images: PMC10757051_01
case_images: 18F-FDG PET/CT imaging. a. Maximum intensity projection (MIP) and b. axial fused PET/CT images showed abnormal 18F-FDG uptake in multiple sites (arrows) including the bilateral lacrimal and salivary glands; duodenum; pancreas; retroperitoneum; lymph nodes (mediastinal, bilateral bronchopulmonary, abdominal para-aorta and mesentery)
case_images: AOJNMB-12-52-g001.jpg
case_images: PMC10757051_01_AOJNMB-12-52-g001.jpg
case_images: F1
case_images: The imaging revealed abnormal 18F-FDG uptake was observed in various locations, including the bilateral lacrimal and salivary glands, duodenum, pancreas, retroperitoneum and multiple lymph nodes (mediastinal, bilateral broncho-pulmonary, abdominal para-aorta, and mesentery) (Figures 1a, b-arrows).
case_images: Immunohistochemical features. a, b. numerous lymphoid cells expressed IgG4 in the left submandibular gland and duodenum (IgG4 staining, 100x). Bar, 100 mum. c, d. plasmacytic cells were CD138-focally positive in the left submandibular gland and duodenum (CD138 staining, 100x). Bar, 100 mum. e, f, g. IgG4-positive lymphoid cells in the left submandibular gland showed immunoglobulin kappa-light chain monotype restriction (IgG4, kappa-light chain and lambda-light chain staining, 200x). Bar, 50 mum
case_images: AOJNMB-12-52-g002.jpg
case_images: PMC10757051_01_AOJNMB-12-52-g002.jpg
case_images: F2
case_images: In both the left submandibular gland and duodenum, numerous lymphoid cells exhibited positive staining for IgG4 (Figures 2a, b), and plasmacytic cells showed focal positively for CD138 (Figures 2c, d). Moreover, the IgG4-positive lymphoid cells in the left submandibular gland displayed immuno-globulin kappa-light chain monotype restriction (Figures 2e, f, g) and a monoclonal rearrangement of the immunoglobulin heavy chain gene was also demonstrated.
case_images: Plain CT imaging. a. Prior to systemic therapy, the bilateral lacrimal glands, bilateral submandibular glands, pancreas and retroperitoneum exhibit enlargement (arrows). b. Following systemic therapy, these lesions demonstrate a tendency towards amelioration of swelling at multiple sites (arrows)
case_images: AOJNMB-12-52-g003.jpg
case_images: PMC10757051_01_AOJNMB-12-52-g003.jpg
case_images: F3
case_images: Whole-body plain CT scan demonstrated an improvement in swelling across multiple sites (Figures 3a, b).