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要約 目的:両側の涙腺腫脹を呈した抗免疫グロブリンG4(IgG4)関連涙腺炎の2症例の報告。症例:症例は68歳女性と69歳男性で,1例は両側の上眼瞼と顎下腺腫脹,他の1例は片側の上眼瞼腫脹で受診した。両症例とも磁気共鳴画像(MRI)で両側の涙腺腫脹があった。1例では顎下腺の生検でリンパ球と形質細胞のびまん性浸潤,他の1例では摘出した涙腺にリンパ組織の過形成があり,両症例とも免疫染色で多数のIgG4陽性細胞があった。両症例とも血清IgG4値が高値を示した。1例は副腎皮質ステロイド薬の経口投与で改善し,他の1例は無治療で29か月間悪化はない。結論:両側の涙腺腫脹がある症例では,血清IgG4の測定と,涙腺または顎下腺の生検がIgG4関連涙腺炎の診断に有効である。
Abstract. Purpose:To report two cases of immune-globulin G4(IgG4)-related dacryoadenitis with bilateral swelling of lacrimal gland. Cases:The present series comprised a female and male aged 68 and 69 years respectively. One showed bilateral swelling of eyelids and submandibular gland and the other with unilateral swelling of the eyelid. Magnetic resonance imaging(MRI)showed bilateral swelling of lacrimal gland in both cases. Biopsy of submandibular gland showed diffuse infiltration of lymphocytes and plasma cells in one case. Surgically excised lacrimal gland in the other case showed lymphoid hyperplasia. Immuno-staining showed abundant IgG4-positive cells in both cases. Both cases showed elevated serum levels of IgG4. One case improved after peroral corticosteroid. The other case has been doing well for 29 months without treatment. Conclusion:Biopsy and measurement of serum level of IgG4 are useful in the diagnosis of IgG4-related dacryoadenitis in the presence of bilaterally swollen lacrimal gland.
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