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Breast lesions arising from IgG4-related diseases are rare and can be difficult to differentiate from breast cancer based on only imaging findings. A 46 year-old female was referred to our hospital complaining of swelling in her bilateral submandibular gland. Contrast-enhanced CT displayed the bilateral swelling of the submandibular gland, a pancreas mass, and a right breast mass. A needle biopsy of the breast showed a dense infiltration of lymphocytes and plasma cells with accompanying stromal fibrosis, as well as positive immunohistochemical reactions for IgG4 and increased IgG4 serum levels. These findings resulted in a diagnosis of IgG4-related disease, and oral steroid treatment was initiated. The breast tumor disappeared after 6 months. [ABSTRACT FROM AUTHOR]

目的：特発性大腿骨頭壊死症患者（ONFH）が股関節以外に骨壊死を引き起こす多発骨壊死は, 3 関節 以上と定義した際には約3％とこれまで報告されてきた。一方で, 無症候性壊死を検出感度の高い全身 MRI を用いた先行研究では, ONFH 患者の約25％に多発骨壊死が発生し全例ステロイド関連ONFH で あった。そこで本研究は, ステロイド関連ONFH 症例を対象として, 多発骨壊死の関連性を調査する ことを目的とした。 方法：対象は当院における定点モニタリング対象となったONFH 症例328 名のうち, 特発性ONFH 9 名, アルコール関連ONFH 75 名およびデータ詳細不明の16 名を除外したステロイド関連ONFH 228 名（男性108 名, 女性120 名）である。基礎疾患, ステロイド投与最大量, ステロイドパルス療法, ア ルコール, 喫煙, 股関節以外の関節の骨壊死発生を調査した。 結果：多発骨壊死は228 名中59 名（男性24 名, 女性35 名）に生じていた。多発骨壊死症を生じた ONFH 症例は, 若年, 両側ONFH 症例, ステロイド高用量, ステロイドパルス症例, 喫煙, 全身性エ リテマトーデス症例の傾向があった。多変量解析を行ったところ, ステロイドパルス（オッズ比3.0 倍, P＝0.008）が多発骨壊死の独立した関連因子であった。 考察・結論：ONFH 発生に関してステロイド投与量やステロイドパルスが関連することと同様に, 多発 骨壊死とステロイドパルスは関連したことから多発骨壊死発生もステロイド感受性が関連することが 示唆された。多発性骨壊死発生のメカニズムはわかっていないが, ステロイド関連ONFH が発生した 際には, 多発骨壊死のスクリーニングを行うことを考慮する必要があると考えられた. [ABSTRACT FROM AUTHOR]

A 72-year-old woman with a history of autoimmune hemolytic anemia (AIHA) in X-4 had been experiencing generalized malaise since September X. She was diagnosed as AIHA exacerbation and began steroid therapy. Cytology was negative, and cystoscopy showed mucosal irregularities rich in angiogenesis from the bilateral ureteral orifice to the bladder triangle. It was difficult to distinguish this case from bladder cancer, and TURBT was performed in November X. Since the patient was under steroid treatment for AIHA, the proliferative cystitis was also followed up with the same treatment. The anemia tended to improve, and cystoscopy showed no mucosal irregularities, although mild redness remained. Ultrasonography showed that the left hydronephrosis had disappeared and there was no obvious recurrence. Proliferative cystitis is often detected by gross hematuria and dysuria, but there are also reported cases where it was detected by imaging examination due to bladder wall thickening and hydronephrosis. Chronic inflammation, irritation, genetics, and immunity have been suggested as causes of the disease. It is difficult to distinguish such cases from malignancy by diagnostic imaging and cystoscopy, and TURBT is often performed as a diagnostic treatment. Antibiotics and anti-inflammatory drugs are often the first line of treatment after diagnosis, but there have been reports of improvement with corticosteroids, as happened in this case. [ABSTRACT FROM AUTHOR]