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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Retroperitoneal fibrosis &#40;RPF&#41; associated with IgG4 is a disease of inflammatory and autoimmune origen&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> A rate of 1&#47;100&#44;000 and prevalence of 1&#46;4&#47;100&#44;000<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> have been reported&#46; The average age at diagnosis is 50 and it presents 2&#8211;3 times more in men than in women&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> It is characterised by the histopathological appearance of a high number of IgG4<span class="elsevierStyleSup">&#43;</span> plasmatic cells&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 55-year-old patient with a diagnosis of RPF associated with IgG4 and surgically treated by resection&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 55-year-old woman who had had a caesarean section 21 years before and an open appendectomy 3 years before&#44; with no history of pancreatitis&#46; She presented with a 4-month history of pain in the left flank that irradiated to the lumbar region&#44; with no other symptoms on examination and no signs of dry syndrome or palpable lymphadenopathies&#46; Computed tomography of the abdomen revealed a cystic tumour in the retroperitoneal region which compressed the ureter and the left pyelokaliceal system in contact with the pancreatic body and tail&#46; Biochemical tests were requested which reported 95 serous amylase&#44; 38 lipase&#44; CA 19-9 antigen&#58; 23&#46;6 and CA 125&#58; 6&#46;4&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A double-J catheter was inserted into the left ureter with discreet resistance in its path and a surgical approach was decided upon&#46; A solid tumour was found to be attached to the deep tissues in the retroperitoneal space&#44; to the left of the inferior vena cava&#44; which protruded through the mesentery and was in close contact with the kidney&#44; left pelvis and anterior surface of the aorta&#44; where signs of major inflammation were observed&#46; A surgical specimen was sent to the pathology department for examination&#44; comprising the tumour&#44; left kidney and perirenal and suprarrenal ipsolateral fat&#46; The postoperative period passed without event and the patient was discharged on day three&#46; The patient is currently being managed by the rheumatology department with low doses of steroids&#44; has not presented with any relapses and does not require corticosteroid-sparing agents&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The definitive pathological report diagnosed nodular retroperitoneal fibrosis associated with IgG4&#44; with Ki67-positive in germinal centres &#40;5&#37;&#41; and IgG4-postiive &#40;40 plasma cells in 3 fields of 40&#215;&#41; by immunohistochemistry &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">IgG4-related disease was the name given during the previous decade to an entity characterised by swelling lesions&#44; dense lymphoplasmacytic infiltrate with abundant IgG4 positive cells&#44; storiform fibrosis and frequently&#44; but not always&#44; raised IgG4<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> serous levels&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">RPF is a rare inflammatory process which involves the retroperitoneal region on the fourth lumbar vertebra&#44; may involve and compress one or both ureters in over 60&#37; of cases and the abdominal vasculature &#40;aorta and inferior vena cava&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a> in general&#44; RPF is divided into 2 types&#58; idiopathic RF &#40;IRPF&#41;&#44; where there is no one direct cause for its appearance and which is essentially a diagnosis of exclusion&#44; and secondary RF &#40;SRPF&#41; which is associated with several causes such as drugs&#44; diverse infections and malignant tumours&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2&#44;5</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; At present&#44; Riedel thyroiditis &#40;fibrosing thyroiditis&#41;&#44; K&#252;ttner tumour &#40;increase in the size of submandibular glands with fribrosis within them&#41;&#44; RPF and Mikulicz disease are classified within the IgG4<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a>-related disease spectrum&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The most common RPF symptoms include abdominal pain&#44; jaundice from oedema and infiltrate of pancreatic and bile ducts&#44; weight loss and exocrine or endocrine pancreatic failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;3</span></a> There is no internationally accepted criteria for the diagnosis of IgG4-related diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Three histopathological findings present in the patient and define the disease in the affected organ&#46; They are as follows&#58; &#40;1&#41; the presence of storiform pattern sclerosis&#59; &#40;2&#41; a dense lymphoplasmacytic infiltrate and &#40;3&#41; a raised proportion of IgG4 positive cells from immunohistochemistry compared with IgG1 positive cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The first line of treatment in RPF is renal level decompression through drainage&#44; as in the case of our patient&#44; combined with high steroid dose therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> The goals are to induce regression of fibroinflammatory reaction&#44; release the ureteral and retroperitoneal structure obstruction&#44; stop the acute inflammatory reaction phase and its systemic manifestations and prevent recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> However&#44; it has been reported that in cases where the fibrosis component predominates&#44; a surgical approach may be useful&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Disease remission has been reported in up to 75&#37;&#8211;95&#37; of cases but relapses are frequent&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;3</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">RPF should form part of the differential diagnosis in the case of retroperitoneal tumours&#44; since a timely diagnosis will improve treatment&#44; patient follow-up and prognosis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Liabilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of people and animals</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experimentation has been carried out on human beings or animals&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Data confidentiality</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to the protocol of their place of work on the publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of Interests</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        1 => array:2 [
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          "titulo" => "Introduction"
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          "titulo" => "Ethical Liabilities"
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              "titulo" => "Protection of people and animals"
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              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
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        10 => array:1 [
          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2017-03-18"
    "fechaAceptado" => "2017-06-10"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1165525"
          "palabras" => array:4 [
            0 => "Immunoglobulin IgG4"
            1 => "Immunoglobulin IgG4-related disease"
            2 => "Retroperitoneal fibrosis"
            3 => "Retroperitoneal tumors"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1165526"
          "palabras" => array:4 [
            0 => "Inmunoglobulina IgG4"
            1 => "Enfermedad asociada a inmunoglobulina IgG4"
            2 => "Fibrosis retroperitoneal"
            3 => "Tumores retroperitoneales"
          ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The patient was a 55-year-old woman with a 4-month history of pain in left flank that irradiated to the lumbar region&#46; Computed tomography revealed a cystic tumor in the retroperitoneal region that compresses the ureter and left renal pelvis in contact with pancreatic body and tail&#46; Surgery was performed and the definitive pathological report diagnosed nodular retroperitoneal fibrosis associated with IgG4&#59; Ki67-positive in germinal centers &#40;5&#37;&#41; and IgG4-positive &#40;40 plasma cells in 3 fields of 40&#215;&#41; by immunohistochemistry&#46; Retroperitoneal fibrosis is a rare disease&#44; that develops gradually and has an excellent response to steroid management&#46; Surgical treatment is reserved for cases that compromise adjacent structures&#46; Thus&#44; identifying it when studying a retroperitoneal tumor leads to better prognosis and survival&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Paciente de 55 a&#241;os de edad con cuadro de dolor en flanco izquierdo irradiado a regi&#243;n lumbar de 4 meses de evoluci&#243;n&#44; con tomograf&#237;a axial computarizada que reporta tumoraci&#243;n qu&#237;stica en regi&#243;n retroperitoneal que comprime ur&#233;ter y sistema pielocaliceal izquierdo en contacto con cuerpo y cola de p&#225;ncreas&#46; Es intervenida quir&#250;rgicamente y se encuentra en reporte patol&#243;gico definitivo fibrosis retroperitoneal nodular asociada a IgG4&#59; con Ki67 positivo en centros germinales &#40;5&#37;&#41; e IgG4 positivo &#40;40 c&#233;lulas plasm&#225;ticas en 3 campos de 40&#215;&#41; por inmunohistoqu&#237;mica&#46; La fibrosis retroperitoneal nodular es una enfermedad poco frecuente&#44; de evoluci&#243;n paulatina con excelente respuesta al manejo con esteroides&#46; El tratamiento quir&#250;rgico se reserva para casos que comprometen estructuras adyacentes&#44; por lo que el identificarlo al estudiar una tumoraci&#243;n retroperitoneal conlleva un mejor pron&#243;stico y sobrevida&#46;</p></span>"
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    "NotaPie" => array:1 [
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ruiz Mar G&#44; C&#225;rdenas Serrano &#211;E&#44; Roldan Garc&#237;a J&#44; Ca&#241;avera-Constantino A&#44; Men&#233;ndez Trejo VM&#44; Chapa Azuela &#211;&#46; Fibrosis retroperitoneal nodular asociada a IgG4 como diagn&#243;stico diferencial en tumores retroperitoneales&#46; Reporte de un caso&#46; Reumatol Clin&#46; 2019&#59;15&#58;e27&#8211;e29&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "mostrarDisplay" => false
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Macroscopic tumour&#46; &#40;B&#41; Surgical specimen&#44; solid well defined tumour&#44; fibrous in appearance&#44; which does not invade the renal parenchyma&#46; &#40;C&#41; Microphotography &#40;40&#215;&#41;&#46; Reaction of the indirect immunoperoxidase with anti-IgG4 antibody&#44; with over 40 plasmatic cells&#46; &#40;D&#41; Microphotography &#40;40&#215;&#41; with Mason staining&#46; Fibrosis with focally steriform pattern&#46; &#40;E&#41; Microphotography &#40;100&#215;&#41;&#46; Inflammatory infiltrate predominantly composed of plasmatic cells&#46; &#40;F&#41; Microphotography &#40;10&#215;&#41; obliterating phlebitis consistent with extensive fibrosis and lymphoplasmacytic infiltrate&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Source&#58; taken from Corradi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idiopathic</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IgG4-related&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Frequency is unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Drugs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Analgesics&#44; betablockers&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Malignant diseases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Malignant lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tuberculoses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Radiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Colon or pancreatic cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lymphadenectomy&#44; colectomy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Trauma&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Causes of Retroperitoneal Fibrosis&#46;</p>"
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    ]
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enfermedad relacionada con IgG4&#58; revisi&#243;n concisa de la literatura"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "O&#46; Ardilla-Suarez"
                            1 => "A&#46; Abril"
                            2 => "J&#46; G&#243;mez-Puerta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.reuma.2016.05.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reumatol Clin"
                        "fecha" => "2017"
                        "volumen" => "13"
                        "paginaInicial" => "160"
                        "paginaFinal" => "166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27329319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retroperitoneal fibrosis associated with immunoglobulin G4-related disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Fujimori"
                            1 => "T&#46; Ito"
                            2 => "H&#46; Igarashi"
                            3 => "T&#46; Ogno"
                            4 => "T&#46; Nakamura"
                            5 => "Y&#46; Niina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3748/wjg.v19.i1.35"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "35"
                        "paginaFinal" => "41"
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Case Report
Retroperitoneal Fibrosis Associated With Immunoglobulin IgG4-related Disease in the Differential Diagnosis in Retroperitoneal Tumours. Case Report
Fibrosis retroperitoneal nodular asociada a IgG4 como diagnóstico diferencial en tumores retroperitoneales. Reporte de un caso
Gabriela Ruiz Mara,
Corresponding author
rvgaby@hotmail.com

Corresponding author.
, Óscar E. Cárdenas Serranob, Jorge Roldan Garcíac, Abraham Cañavera-Constantinod, Víctor M. Menéndez Trejoe, Óscar Chapa Azuelaf
a Servicio de Cirugía General, Hospital General de México, Mexico City, Mexico
b Servicio de Oncología Ginecológica, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
c Servicio de Cirugía, Hospital General de Cholula, San Bernardino Tlaxcalancingo, San Andrés Cholula, Puebla, Mexico
d Servicio de Patología, Hospital General de México, Mexico City, Mexico
e Servicio de Cirugía, Hospital General de México, Mexico City, Mexico
f Clínica de Cirugía Hepatopancreatobiliar, Hospital General de México, Mexico City, Mexico
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    "titulo" => "Retroperitoneal Fibrosis Associated With Immunoglobulin IgG4-related Disease in the Differential Diagnosis in Retroperitoneal Tumours&#46; Case Report"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Macroscopic tumour&#46; &#40;B&#41; Surgical specimen&#44; solid well defined tumour&#44; fibrous in appearance&#44; which does not invade the renal parenchyma&#46; &#40;C&#41; Microphotography &#40;40&#215;&#41;&#46; Reaction of the indirect immunoperoxidase with anti-IgG4 antibody&#44; with over 40 plasmatic cells&#46; &#40;D&#41; Microphotography &#40;40&#215;&#41; with Mason staining&#46; Fibrosis with focally steriform pattern&#46; &#40;E&#41; Microphotography &#40;100&#215;&#41;&#46; Inflammatory infiltrate predominantly composed of plasmatic cells&#46; &#40;F&#41; Microphotography &#40;10&#215;&#41; obliterating phlebitis consistent with extensive fibrosis and lymphoplasmacytic infiltrate&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Retroperitoneal fibrosis &#40;RPF&#41; associated with IgG4 is a disease of inflammatory and autoimmune origen&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> A rate of 1&#47;100&#44;000 and prevalence of 1&#46;4&#47;100&#44;000<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> have been reported&#46; The average age at diagnosis is 50 and it presents 2&#8211;3 times more in men than in women&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> It is characterised by the histopathological appearance of a high number of IgG4<span class="elsevierStyleSup">&#43;</span> plasmatic cells&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 55-year-old patient with a diagnosis of RPF associated with IgG4 and surgically treated by resection&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 55-year-old woman who had had a caesarean section 21 years before and an open appendectomy 3 years before&#44; with no history of pancreatitis&#46; She presented with a 4-month history of pain in the left flank that irradiated to the lumbar region&#44; with no other symptoms on examination and no signs of dry syndrome or palpable lymphadenopathies&#46; Computed tomography of the abdomen revealed a cystic tumour in the retroperitoneal region which compressed the ureter and the left pyelokaliceal system in contact with the pancreatic body and tail&#46; Biochemical tests were requested which reported 95 serous amylase&#44; 38 lipase&#44; CA 19-9 antigen&#58; 23&#46;6 and CA 125&#58; 6&#46;4&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A double-J catheter was inserted into the left ureter with discreet resistance in its path and a surgical approach was decided upon&#46; A solid tumour was found to be attached to the deep tissues in the retroperitoneal space&#44; to the left of the inferior vena cava&#44; which protruded through the mesentery and was in close contact with the kidney&#44; left pelvis and anterior surface of the aorta&#44; where signs of major inflammation were observed&#46; A surgical specimen was sent to the pathology department for examination&#44; comprising the tumour&#44; left kidney and perirenal and suprarrenal ipsolateral fat&#46; The postoperative period passed without event and the patient was discharged on day three&#46; The patient is currently being managed by the rheumatology department with low doses of steroids&#44; has not presented with any relapses and does not require corticosteroid-sparing agents&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The definitive pathological report diagnosed nodular retroperitoneal fibrosis associated with IgG4&#44; with Ki67-positive in germinal centres &#40;5&#37;&#41; and IgG4-postiive &#40;40 plasma cells in 3 fields of 40&#215;&#41; by immunohistochemistry &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">IgG4-related disease was the name given during the previous decade to an entity characterised by swelling lesions&#44; dense lymphoplasmacytic infiltrate with abundant IgG4 positive cells&#44; storiform fibrosis and frequently&#44; but not always&#44; raised IgG4<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> serous levels&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">RPF is a rare inflammatory process which involves the retroperitoneal region on the fourth lumbar vertebra&#44; may involve and compress one or both ureters in over 60&#37; of cases and the abdominal vasculature &#40;aorta and inferior vena cava&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a> in general&#44; RPF is divided into 2 types&#58; idiopathic RF &#40;IRPF&#41;&#44; where there is no one direct cause for its appearance and which is essentially a diagnosis of exclusion&#44; and secondary RF &#40;SRPF&#41; which is associated with several causes such as drugs&#44; diverse infections and malignant tumours&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2&#44;5</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; At present&#44; Riedel thyroiditis &#40;fibrosing thyroiditis&#41;&#44; K&#252;ttner tumour &#40;increase in the size of submandibular glands with fribrosis within them&#41;&#44; RPF and Mikulicz disease are classified within the IgG4<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a>-related disease spectrum&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The most common RPF symptoms include abdominal pain&#44; jaundice from oedema and infiltrate of pancreatic and bile ducts&#44; weight loss and exocrine or endocrine pancreatic failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;3</span></a> There is no internationally accepted criteria for the diagnosis of IgG4-related diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Three histopathological findings present in the patient and define the disease in the affected organ&#46; They are as follows&#58; &#40;1&#41; the presence of storiform pattern sclerosis&#59; &#40;2&#41; a dense lymphoplasmacytic infiltrate and &#40;3&#41; a raised proportion of IgG4 positive cells from immunohistochemistry compared with IgG1 positive cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The first line of treatment in RPF is renal level decompression through drainage&#44; as in the case of our patient&#44; combined with high steroid dose therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> The goals are to induce regression of fibroinflammatory reaction&#44; release the ureteral and retroperitoneal structure obstruction&#44; stop the acute inflammatory reaction phase and its systemic manifestations and prevent recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> However&#44; it has been reported that in cases where the fibrosis component predominates&#44; a surgical approach may be useful&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Disease remission has been reported in up to 75&#37;&#8211;95&#37; of cases but relapses are frequent&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;3</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">RPF should form part of the differential diagnosis in the case of retroperitoneal tumours&#44; since a timely diagnosis will improve treatment&#44; patient follow-up and prognosis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical Liabilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of people and animals</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experimentation has been carried out on human beings or animals&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Data confidentiality</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to the protocol of their place of work on the publication of patient data&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of Interests</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The patient was a 55-year-old woman with a 4-month history of pain in left flank that irradiated to the lumbar region&#46; Computed tomography revealed a cystic tumor in the retroperitoneal region that compresses the ureter and left renal pelvis in contact with pancreatic body and tail&#46; Surgery was performed and the definitive pathological report diagnosed nodular retroperitoneal fibrosis associated with IgG4&#59; Ki67-positive in germinal centers &#40;5&#37;&#41; and IgG4-positive &#40;40 plasma cells in 3 fields of 40&#215;&#41; by immunohistochemistry&#46; Retroperitoneal fibrosis is a rare disease&#44; that develops gradually and has an excellent response to steroid management&#46; Surgical treatment is reserved for cases that compromise adjacent structures&#46; Thus&#44; identifying it when studying a retroperitoneal tumor leads to better prognosis and survival&#46;</p></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Paciente de 55 a&#241;os de edad con cuadro de dolor en flanco izquierdo irradiado a regi&#243;n lumbar de 4 meses de evoluci&#243;n&#44; con tomograf&#237;a axial computarizada que reporta tumoraci&#243;n qu&#237;stica en regi&#243;n retroperitoneal que comprime ur&#233;ter y sistema pielocaliceal izquierdo en contacto con cuerpo y cola de p&#225;ncreas&#46; Es intervenida quir&#250;rgicamente y se encuentra en reporte patol&#243;gico definitivo fibrosis retroperitoneal nodular asociada a IgG4&#59; con Ki67 positivo en centros germinales &#40;5&#37;&#41; e IgG4 positivo &#40;40 c&#233;lulas plasm&#225;ticas en 3 campos de 40&#215;&#41; por inmunohistoqu&#237;mica&#46; La fibrosis retroperitoneal nodular es una enfermedad poco frecuente&#44; de evoluci&#243;n paulatina con excelente respuesta al manejo con esteroides&#46; El tratamiento quir&#250;rgico se reserva para casos que comprometen estructuras adyacentes&#44; por lo que el identificarlo al estudiar una tumoraci&#243;n retroperitoneal conlleva un mejor pron&#243;stico y sobrevida&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ruiz Mar G&#44; C&#225;rdenas Serrano &#211;E&#44; Roldan Garc&#237;a J&#44; Ca&#241;avera-Constantino A&#44; Men&#233;ndez Trejo VM&#44; Chapa Azuela &#211;&#46; Fibrosis retroperitoneal nodular asociada a IgG4 como diagn&#243;stico diferencial en tumores retroperitoneales&#46; Reporte de un caso&#46; Reumatol Clin&#46; 2019&#59;15&#58;e27&#8211;e29&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Analgesics&#44; betablockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Malignant diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Malignant lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tuberculoses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Radiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colon or pancreatic cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lymphadenectomy&#44; colectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Original language: English
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Idiomas
Reumatología Clínica (English Edition)
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