case_images: PMC6855009_01
case_images: (a), (b) CECT showing a 3-cm hypervascular tumor (arrow) in the ileocecal region accompanied by small bowel obstruction.
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case_images: PMC6855009_01_CRIGM2019-2530487.001.jpg
case_images: fig1
case_images: Contrast-enhanced computed tomography (CECT) showed a 3-cm hypervascular tumor in the ileocecal region, revealing small bowel obstruction (Figure 1).
case_images: (a) MRI T2-weighted images showing mild high intensity lesions in the ileocecal region (arrow). (b) MRI diffusion-weighted images showing decreased diffusion in lesions (arrow).
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case_images: PMC6855009_01_CRIGM2019-2530487.002.jpg
case_images: fig2
case_images: The lesion emitted slightly high intensity on simple magnetic resonance imaging (MRI) T2-weighted images and showed decreased diffusion on diffusion-weighted images (DWI) (Figure 2).
case_images: Contrast imaging of the ileus tube showing extrinsic compression of the ileocecal region (arrow). TI: terminal ileum, C: cecum, A: Ascending colon.
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case_images: fig3
case_images: Contrast imaging of the ileus tube showed extrinsic compression of the ileocecal region (Figure 3).
case_images: (a) Endoscopy of the lower gastrointestinal tract showing no abnormalities in the mucous membrane of the cecum and ileum. (b) Extramural compression was detected in the terminal ileum (arrow).
case_images: CRIGM2019-2530487.004.jpg
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case_images: fig4
case_images: While endoscopy of the lower gastrointestinal tract revealed no abnormalities in the mucous membrane of the ileum and cecum, the terminal ileum exhibited extramural compression (Figure 4).
case_images: (a) Forward-viewing linear echoendoscope, TGF-UC180J (Olympus Medical Systems Corp, Tokyo, Japan). (b) EUS revealed an irregular hypoechoic tumor measuring 3 cm outside the gastrointestinal tract.
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case_images: fig5
case_images: (a) A specimen obtained by EUS-FNA. Pathologically, the lesion was found to be composed of inflammatory fibrous tissues with lymphoplasmacytic infiltration (Hematoxylin-Eosin Stain, x400). (b) IgG4 staining revealed more than 10 IgG4-positive cells in an HPF (IgG4 Stain x400).
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case_images: fig6
case_images: Pathologically, the lesion was found to comprise inflammatory fibrous tissues with lymphoplasmacytic infiltration, and more than 10 IgG4-positive cells were detected in a high-power field (HPF) (Figure 6).
case_images: (a) Contrast-enhanced MRI showing an irregular tumor in the left maxillary sinus (arrow). (b) Pathologically, diffuse lymphoplasmacytic infiltration and storiform fibrosis are observed (Hematoxylin-Eosin Stain, x200). (c) More than 50 IgG4-positive cells are observed in an HPF (IgG4 Stain, x400).
case_images: CRIGM2019-2530487.007.jpg
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case_images: fig7
case_images: Contrast-enhanced MRI revealed an irregular tumor showing contrast in the left maxillary sinus (Figure 7). IgG4-positive cells in an HPF, which was consistent with IgG4-RD (Figure 7). IgG staining was difficult because it involved co-staining.
case_images: (a) CECT showing complete disappearance of the tumor at 2 months after steroid treatment (arrow). (b) MRI diffusion-weighted images indicate the absence of any lesion (arrow).
case_images: CRIGM2019-2530487.008.jpg
case_images: PMC6855009_01_CRIGM2019-2530487.008.jpg
case_images: fig8
case_images: CT and MRI performed 2 months later showed complete disappearance of the ileocecal tumor (Figure 8).