Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3429-3434
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3429
Rare case of Helicobacter pylori-positive multiorgan IgG4-related disease and gastric cancer
Min Li, Qiang Zhou, Kun Yang, David R Brigstock, Lu Zhang, Ming Xiu, Li Sun, Run-Ping Gao
Min Li, Qiang Zhou, Kun Yang, Lu Zhang, Ming Xiu, Li Sun, Run-Ping Gao, Department of Hepatic-Biliary-Pancreatic Medicine, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
David R Brigstock, The Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, United States
David R Brigstock, Division of Pediatric Surgery, Department of Surgery, The Ohio State University, Columbus, OH 43205, United States
Author contributions: Li M, Zhou Q, Yang K, Zhang L, Xiu M, and Sun L contributed to the data collection; Gao RP designed the study and wrote the manuscript; Brigstock DR coordinated the study and edited the manuscript.
Supported by National Natural Scientific Foundation of China (to Gao RP), No. 81070370 and No. 81270544.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Run-Ping Gao, Professor, MD, PhD, Department of Hepatic-Biliary-Pancreatic Medicine, The First Hospital of Jilin University, No. 71 Xinmin Avenue, Changchun 130021, Jilin Province, China. gao_runping@yahoo.com
Telephone: +86-431-88785110 Fax: +86-431-65612468
Received: September 15, 2014
Peer-review started: September 19, 2014
First decision: October 29, 2014
Revised: November 17, 2014
Accepted: December 22, 2014
Article in press: December 22, 2014
Published online: March 21, 2015
Processing time: 185 Days and 2.5 Hours
Abstract

A 61-year-old male from Northeast China presented with a 2-mo history of abdominal distension, pruritus and jaundice. Laboratory testing revealed an elevated serum IgG4 level. A computed tomography scan showed a typical feature of autoimmune pancreatitis (AIP) and cholecystocholangitis. Early gastric cancer was incidentally discovered when endoscopic untrasound-guided fine needle aspiration (EUS-FNA) of the pancreas was carried out. The patient underwent radical subtotal gastrectomy for gastric cancer combined with cholecystectomy. Helicobacter pylori (H. pylori) and IgG4-positive plasmacytes were detected in gastric cancer tissue, pancreatic EUS-FNA sample and resected gallbladder specimen by immunohistochemistry. The patient was diagnosed with H. pylori-positive IgG4-related AIP and sclerosing cholecystocholangitis as well as H. pylori-positive gastric cancer. He responded well to steroid therapy and remains healthy with no signs of recurrence at one year follow-up. We speculate that H. pylori might act as a trigger via direct or indirect action in the initiation of onset of gastric cancer and multiorgan IgG4-related disease.

Keywords: IgG4-related disease; Helicobacter pylori; Type 1 autoimmune pancreatitis; Sclerosing cholecystocholangitis; Gastric cancer

Core tip: We report a rare case of a 61-year-old male patient who suffered from Helicobacter pylori (H. pylori)-positive IgG4-related autoimmune pancreatitis and sclerosing cholecystocholangitis as well as H. pylori-positive gastric cancer. The patient responded well to corticosteroid therapy after he underwent radical subtotal gastrectomy for gastric cancer combined with cholecystectomy. This report supports the role of H. pylori in the initiation of onset of gastric cancer and multiorgan IgG4-related disease.