ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Spinal nerve root IgG4-related inflammatory pseudotumor mimicking a malignant spinal tumor: a case report.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder characterized by tumefactive lesions, dense infiltration of IgG4-positive plasma cells, and variable organ involvement. Inflammatory pseudotumors associated with IgG4-RD are uncommon, and spinal nerve root involvement is exceedingly rare. Such lesions may closely mimic malignant spinal tumors on imaging, posing significant diagnostic challenges. CASE REPORT: We report the case of a 55-year-old woman who presented with progressive lower back pain and urinary incontinence. Magnetic resonance imaging revealed a space-occupying lesion in the left L1/2 intervertebral foramen. ^18F-FDG positron emission tomography-computed tomography (PET-CT) demonstrated intense focal hypermetabolism with a markedly elevated maximum standardized uptake value (SUVmax) of 11.95, strongly suggesting a malignant process. The patient underwent surgical decompression and tumor resection. Histopathological examination revealed a fibroinflammatory lesion with dense lymphoplasmacytic infiltration and abundant IgG4-positive plasma cells (45/HPF in hotspots), consistent with an IgG4-related inflammatory pseudotumor, despite normal serum IgG4 levels.
conclusionThis case highlights that, despite strong radiological suspicion for malignancy, preoperative biopsy may allow diagnosis of IgG4-RD and enable corticosteroid therapy, potentially avoiding unnecessary radical surgery.
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