# Outologic Manifestations of IgG4-Related Disease: Literature Review and Report of Two Cases
## 3 Case Presentations
### Case 1
\begin{table}
\begin{tabular}{c c c c c c c c c c c} \hline \hline \multirow{2}{*}{**Number**} & \multirow{2}{*}{**Year**} & \multirow{2}{*}{**Location**} & \multirow{2}{*}{**Authors**} & \multirow{2}{*}{**Age**} & \multirow{2}{*}{**Gender**} & \multicolumn{2}{c}{**Initial**} & \multicolumn{2}{c}{**Number of**} & \multicolumn{2}{c}{**Another**} & \multirow{2}{*}{**Biopsy**} & \multirow{2}{*}{**Pathology**} & \multirow{2}{*}{**IgG4 in Serum**} \\  & & & & & **Diagnosis** & & & & & & & \\  & & & & & & & & & & & \\ \hline
**11** & 2019 & Taiwan & Shao S.A. & \multirow{2}{*}{43} & \multirow{2}{*}{m} & otitis media & \multirow{2}{*}{2} & \multirow{2}{*}{} & plasma cell & IgG4 IgG \textgreater{} & Data not \\  & & & & & with effusion & & & & gramuloma & 40\% & available \\ \hline
**12** & 2016 & USA & [PERSON] et al. & \multirow{2}{*}{61} & \multirow{2}{*}{f} & inflammatory & \multirow{2}{*}{1} & middle & \multirow{2}{*}{} & plasmacyic & IgG4 \\  & & & & & pseudotumor & & & infiltration, storiform & positive \textgreater{} \\  & & & & & & & & & fibrosis and phlebitis & 50 per HPF \\ \hline
**13** & 2022 & Lithuania & Polanskis & \multirow{2}{*}{31} & \multirow{2}{*}{f} & mastoiditis & \multirow{2}{*}{1} & middle & \multirow{2}{*}{} & storiform fibrosis, & IgG4 \\  & & & & & & & & & dense & positive \textgreater{}80 \\  & & & & & & & & & lymphoplastic & & per HPF \\  & & & & & & & & & & \\  & & & & & & & & & & \\  & & & & & & & & & & \\  & & & & & & & & & & \\ \hline
**14** & 2022 & South Africa & Hofmyer L. & \multirow{2}{*}{29} & \multirow{2}{*}{f} & mastoiditis & \multirow{2}{*}{1} & middle & \multirow{2}{*}{} & lymphoplasmacytic & IgG4 \\  & & & & & & & & & & \\  & & & & & & & & & & \\  & & & & & & & & & & \\
**16** & 2019 & Thailand & Chowsilpa & \multirow{2}{*}{19} & \multirow{2}{*}{f} & otitis media & \multirow{2}{*}{1} & \multirow{2}{*}{} & petrous & lymphoplasmacytic & IgG4 \\  & & & & & & & apex & infiltration, fibrosis & & \\ \hline
**17** & 2015 & Chaina & Jingye W. & \multirow{2}{*}{38} & \multirow{2}{*}{m} & inflammatory & \multirow{2}{*}{1} & lymphoplasmacytic & IgG4 \\  & & & & & pseudotumor & & & infiltration, fibrosis & per HPF \\ \hline
**18** & 2016 & Israel & Present & \multirow{2}{*}{48} & \multirow{2}{*}{m} & otitis media & \multirow{2}{*}{1} & \multirow{2}{*}{-} & fibrous tissue/with & IgG4 \\  & & & & & & & & & & \\  & & & & & & & & & \\  & & & & & & & & & \\  & & & & & & & & & \\ \hline
**19** & 2021 & Israel & Present & \multirow{2}{*}{44} & \multirow{2}{*}{m} & \multirow{2}{*}{itis media} & \multirow{2}{*}{1} & \multirow{2}{*}{-} & fibrous tissue, dense & IgG4 25 per \\  & & & & & & & & & \\  & & & & & & & & & inflammation, & \\  & & & & & & & & & \\  & & & & & & & & & \\ \hline \hline \end{tabular}
\end{table} 
Table 1: _Cont._Figure 1: Pre-operative CT scan—case 1. Axial high-resolution temporal bone CT scan and coronal reconstruction show extensive bone destruction at the medial and posterior aspects of the left mastoid bone. Mastoid, middle ear, and external auditory canal are opacified—see yellow arrows). Figure 2: Pre-operative CT scan—case 1. Axial and coronal reconstruction post-contrast head CT shows a large filling defect and enhancement around the sigmoid sinus (delta sign, consistent with sigmoid sinus thrombosis (inner yellow arrow). In the soft tissue there are small subperiosteal abscess formations (outer yellow arrow). The patient underwent a cortical mastoidectomy and decompression of the sigmoid sinus and insertion of a ventilation tube (VT) into the tympanic membrane. Intraoperative findings included granulation tissue in the middle ear, mastoid, and pus from the perisinus area. A considerable amount of granulation tissues was removed and sent for immunohistochemistry histopathological examination. Post-operative management included broad-spectrum antibiotic treatment of parenteral Meropenem. On histologic examination (Figure 3A,B), there was fibrous tissue with chronic active inflammation.