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array:24 [ "pii" => "S1579212919304331" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.06.012" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "2206" "copyright" => "The Author(s)" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:52-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S0300289619302844" "issn" => "03002896" "doi" => "10.1016/j.arbres.2019.06.009" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "2206" "copyright" => "The Authors" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:53-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 821 "formatos" => array:3 [ "EPUB" => 90 "HTML" => 556 "PDF" => 175 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Not Cancer After All: Two Rare Cases of IgG4-Related Lung Disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "55" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Al final, no era cáncer: dos casos infrecuentes de enfermedad pulmonar relacionada con IgG4" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 989 "Ancho" => 1300 "Tamanyo" => 408835 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological and radiological results from case 2: (A) hematoxylin and eosin stain, (B) immunohistochemistry for IgG4-positive plasma cells, (C) CT images at the time of diagnosis, and (D) CT images after 3 months of therapy.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Josué Pinto, Carla Damas, António Morais" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Josué" "apellidos" => "Pinto" ] 1 => array:2 [ "nombre" => "Carla" "apellidos" => "Damas" ] 2 => array:2 [ "nombre" => "António" "apellidos" => "Morais" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212919304331" "doi" => "10.1016/j.arbr.2019.06.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919304331?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302844?idApp=UINPBA00003Z" "url" => "/03002896/0000005600000001/v5_202003060711/S0300289619302844/v5_202003060711/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212919304343" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.06.013" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "2208" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:54-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Pleuroparenchymal Fibroelastosis as Another Potential Lung Toxicity Pattern Induced by Amiodarone" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "54" "paginaFinal" => "56" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fibroelastosis pleuroparenquimal como posible patrón de toxicidad pulmonar inducido por amiodarona" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1738 "Ancho" => 2167 "Tamanyo" => 409240 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest radiograph shows bilateral apical subpleural thickening; (B) coronal CT imaging shows subpleural thickening and reticular opacities with traction bronchiectasis in the parenchyma at the upper lobes, more predominant in the right side; (C) 1 • low magnification showing fibroelastotic scarring; 2 • at high magnification the typical mixture of fragmented elastic fibres and collagen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marcos Oliveira, Natália Melo, Patrícia Caetano Mota, Helder Novais e Bastos, Josèc) Miguel Pereira, Andrèc) Carvalho, Susana Guimarães, Conceição Souto Moura, António Morais" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Marcos" "apellidos" => "Oliveira" ] 1 => array:2 [ "nombre" => "Natália" "apellidos" => "Melo" ] 2 => array:2 [ "nombre" => "Patrícia Caetano" "apellidos" => "Mota" ] 3 => array:2 [ "nombre" => "Helder Novais" "apellidos" => "e Bastos" ] 4 => array:2 [ "nombre" => "Josèc) Miguel" "apellidos" => "Pereira" ] 5 => array:2 [ "nombre" => "Andrèc)" "apellidos" => "Carvalho" ] 6 => array:2 [ "nombre" => "Susana" "apellidos" => "Guimarães" ] 7 => array:2 [ "nombre" => "Conceição Souto" "apellidos" => "Moura" ] 8 => array:2 [ "nombre" => "António" "apellidos" => "Morais" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0300289619302868" "doi" => "10.1016/j.arbres.2019.06.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302868?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919304343?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000001/v3_202001222229/S1579212919304343/v3_202001222229/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212919303568" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.06.010" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "2203" "copyright" => "The Author(s)" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:51-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "formatos" => array:2 [ "HTML" => 1 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Hypermetabolic bone on <span class="elsevierStyleSup">18</span>F-FDG-PET/CT in a patient with lung cancer: Is it always metastasis?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "51" "paginaFinal" => "52" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipercaptación ósea en" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1203 "Ancho" => 2500 "Tamanyo" => 242357 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">18</span>F-FDG PET/CT scan images showing (on the left) a solid spiculated hypermetabolic nodule (SUVmax7.5), in punctiform contact with the pleura and the fissure, measuring about 14<span class="elsevierStyleHsp" style=""></span>mm, located in the anterior segment of the right upper lobe. Hypermetabolic bone lesion (on the right) with lytic component at the distal end of the right clavicle (SUVmax 8.4).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Clara Martín-Ontiyuelo, Albert Sánchez-Font, Eva Gimeno, Marina Suárez-Piñera, Víctor Curull" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Clara" "apellidos" => "Martín-Ontiyuelo" ] 1 => array:2 [ "nombre" => "Albert" "apellidos" => "Sánchez-Font" ] 2 => array:2 [ "nombre" => "Eva" "apellidos" => "Gimeno" ] 3 => array:2 [ "nombre" => "Marina" "apellidos" => "Suárez-Piñera" ] 4 => array:2 [ "nombre" => "Víctor" "apellidos" => "Curull" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289619302819" "doi" => "10.1016/j.arbres.2019.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302819?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919303568?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000001/v3_202001222229/S1579212919303568/v3_202001222229/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Not Cancer After All: Two Rare Cases of IgG4-Related Lung Disease" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "52" "paginaFinal" => "54" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Josuèc) Pinto, Carla Damas, António Morais" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Josuèc)" "apellidos" => "Pinto" "email" => array:1 [ 0 => "josue.mpinto@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carla" "apellidos" => "Damas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "António" "apellidos" => "Morais" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Pulmonology Department, University Hospital Center of São João, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Medicine of University of Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Al final, no era cáncer: dos casos infrecuentes de enfermedad pulmonar relacionada con IgG4" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1061 "Ancho" => 1300 "Tamanyo" => 370746 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histological and radiological results from case 1: (A′) hematoxylin and eosin stain, (B′) immunohistochemistry for IgG4-positive plasma cells, (C′) CT images at the time of diagnosis, and (D′) CT images after 2 months of therapy with poor compliance.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">IgG4-related disease (IgG4-RD) is an uncommon systemic disorder characterized by sclerosing lesions that can affect almost any anatomical site.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Pulmonary involvement has highly variable clinical and radiological presentations.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> Although IgG4-related lung disease is usually preceded or accompanied by multi-organ involvement,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> rare cases of solely lung involving IgG4-RD have been described.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4•6</span></a> Herein, we report two biopsy-proven cases of IgG4-RD with lung mass as the sole radiographic presentation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">64-Year-old man with a 27<span class="elsevierStyleHsp" style=""></span>mm spiculated mass in the right upper lobe on computed tomography (CT) in the setting of chronic cough with hemoptoic sputum. He was a previous smoker (100 pack-year of smoking). Bronchoscopy showed neither signs of bleeding nor morphological anomalies and bronchoalveolar lavage (BAL) was negative for malignant cells and acid-fast bacilli. Further investigation with positron emission tomography (PET) demonstrated a right upper lobe nodule with standardized uptake value (SUV) max of 2.6. Due to the high suspicion of primary lung malignancy, biopsy of the nodule was performed by transthoracic needle aspiration (TTNA), documenting a fibrocollagenous lesion with lymphoplasmacytic infiltration and wall thickening of venous-type vessels. On immunohistochemistry, the number of IgG4-positive plasma cells was >20 per high power field (HPF) and immunostaining for CD20 and CD3 was positive. The serum concentrations of total IgG and IgG4 were normal.</p><p id="par0015" class="elsevierStylePara elsevierViewall">71-Year-old man who presented with posterior upper thoracic pain for 2 years. He is an active smoker with 50 pack-year of smoking. Chest CT detected a 35<span class="elsevierStyleHsp" style=""></span>mm spiculated mass in the right upper lobe, which was biopsied by TTNA. Histological examination demonstrated a nodular lesion with total architectural distortion due to fibrosis and lymphoplasmacytic infiltration. On immunohistochemistry, the number of IgG4-positive plasma cells was >30 per HPF. Given the suspicion of IgG4-RD further workup was performed, showing elevated serum concentrations of IgG4 and normal concentrations of total IgG. PET demonstrated a right upper lobe nodule with SUV max of 3.1 and BAL pathological analysis was negative for malignant cells. Hence, in both cases the diagnosis of IgG4-RD was established based on clinico-pathological correlation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Both patients started corticosteroid therapy with an initial prednisolone dosing of 0.6<span class="elsevierStyleHsp" style=""></span>mg/kg/d for 4 weeks. Patient 1 had a poor compliance to the treatment and presented no improvements after 2 months (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Patient 2 showed clinical improvement and a reduction of the mass
tm) dimensions on CT imaging after 3 months of treatment (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The prednisolone dose was tapered by 10<span class="elsevierStyleHsp" style=""></span>mg/kg/d after the first and third month of therapy, maintaining 10<span class="elsevierStyleHsp" style=""></span>mg/d at the present time.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Although the epidemiology of IgG4-related lung disease (IgG4-RLD) remains poorly described,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> it usually occurs in male adults with an average age of 69 years.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> Its clinical presentation depends on the location of the lesion, nonetheless half of patients present nonspecific respiratory symptoms, whereas the remaining present abnormalities on imaging studies in the absence of symptoms.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2,8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Appropriate diagnosis can be challenging, as it relies upon the integration of clinical, laboratorial and histopathologic findings. The consensus statement on the pathology of IgG4-RD mentions that the final diagnosis requires both an appropriate histologic appearance and increased numbers of IgG4+ plasma cells.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Such statement suggested >50/HPF and >20/HPF as the cut-off value for increased IgG4+ cells in surgical and nonsurgical biopsies, respectively.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Additionally, it underlines that diagnosis should be based primarily on morphological appearance and less importantly on tissue IgG4+/IgG+ ratio, since various conditions can course with elevated IgG4+/IgG+ ratio.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1,2</span></a> While pathologic findings represent the cornerstone for a definite diagnosis, the interpretation of lung biopsy for any fibroinflammatory condition is challenging due to the fact that the lung tends to undergo stereotypic morphologic responses regardless of the type of injury.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> The characteristic histologic findings of IgG4-RLD are fairly common in lung samples afflicted by severe infection or organizing injury of various causes,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> highlighting the importance of a careful correlation with clinical and laboratorial data.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Elevation of IgG4 serum concentration is used to support the diagnosis of IgG4-RD.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> However, recent studies have demonstrated that up to half of patients with biopsy-proven and clinically active IgG4-RD may have normal serum concentrations<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> and only a minority of patients with high IgG4 levels have IgG4-RD.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> Thus the current trend is to deemphasize excessive reliance on serum IgG4, which is neither specific nor sensitive of IgG4-RD.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">PET has been advocated as it can detect unforeseen localizations of the disease and assess the extent of systemic disease.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> In both patients, PET confirmed that the disease is confined to the lung. Two other case reports documented pulmonary, hilar and mediastinal lesions with SUV max from 2.1 to 11.0,<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6,12</span></a> yet there is no demonstrated range for SUV that can either gauge disease activity or guide treatment decisions.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The natural course of the disease is not completely known and there are no formal treatment guidelines. However, it is agreed among experts that the threshold for initiating treatment is low, in order to prevent fibrosis and its irreversible damage on organs.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> The consensus statement on the treatment of IgG4-RD recommends glucocorticoids as the first-line agent for remission induction in all patients with active and untreated disease.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> Prednisolone at an initial dosage of 0.6<span class="elsevierStyleHsp" style=""></span>mg/kg/d for 2•4 weeks is recommended,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> which may be adjusted if the disease appears to be particularly aggressive.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> Immunossupression with rituximab is indicated in the steroid refractory disease.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> There is no consensus regarding the tapering regimen and maintenance therapy however.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In cases of isolated pulmonary disease, it is imperative to ensure a regular follow-up with screening of multi-systemic involvement and malignancies. Although the association of lung cancer with IgG4-RLD remains unclear, a small number of adenocarcinoma-associated cases have been reported.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, IgG4-RLD is a rare condition that may be diagnosed after the unexpected result of a biopsy in the setting of suspected lung malignancy. Awareness of IgG4-RD is of utmost importance, as the pathologist must perform a specific immunostaining and the clinician must exclude other differential diagnoses. Increasing recognition and further studies will enlighten our understanding of the pathogenesis, diagnostic criteria and standardized therapy for this disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1061 "Ancho" => 1300 "Tamanyo" => 370746 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histological and radiological results from case 1: (A′) hematoxylin and eosin stain, (B′) immunohistochemistry for IgG4-positive plasma cells, (C′) CT images at the time of diagnosis, and (D′) CT images after 2 months of therapy with poor compliance.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 989 "Ancho" => 1300 "Tamanyo" => 408835 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological and radiological results from case 2: (A) hematoxylin and eosin stain, (B) immunohistochemistry for IgG4-positive plasma cells, (C) CT images at the time of diagnosis, and (D) CT images after 3 months of therapy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus statement on the pathology of IgG4-related disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. 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