Immunoglobulin G4-related
inflammatory pseudotumors are usually benign. Such
tumors of cardiac origin are extremely rare, with no primary
cardiac tumors reported to date. We report a case of a 77-year-old woman, with a medical history of diabetes,
hypertension, and
hyperlipidemia, who was diagnosed with a malignant
cardiac tumor on preoperative imaging and had a confirmed pathological diagnosis of
immunoglobulin G4-related
inflammatory pseudotumor. She was examined for
atherosclerosis obliterans, and coronary computed tomography revealed obstruction of the right coronary artery and a
cardiac tumor in the right atrium. A suspected malignant
tumor measuring 40 mm (maximum standardized uptake value: 12.2) bordering the right atrium was detected using 18F-fluorodeoxyglucose positron emission tomography. Her
tumor was in contact with the heart, making biopsy impossible. She was diagnosed with
malignancy on preoperative imaging and underwent
tumor resection, tricuspid valve replacement, right atrial and right ventricular plasty,
coronary artery bypass, lung resection, and diaphragmatic repair. However, the final pathological diagnosis was
immunoglobulin G4-related
inflammatory pseudotumor. Preoperative diagnosis of
immunoglobulin G4-related
inflammatory pseudotumor is extremely difficult; however, if the condition is diagnosed preoperatively,
chemotherapy or
steroid therapy should be administered, and patients who do not respond to
chemotherapy should be considered for surgical treatment.
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