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Kim SR, Kim SK, Koma YI, Sasaki M, Asai A, Nishikawa H. Hepatic Inflammatory Pseudotumor-Focusing on Its Heterogeneity. Diagnostics (Basel) 2023; 13:2857. [PMID: 37685395 PMCID: PMC10486865 DOI: 10.3390/diagnostics13172857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Hepatic inflammatory pseudotumors (IPTs) are defined as benign, non-malignant, non-metastasizing tumors characterized by the presence of myofibroblastic spindle cells, hetorogenous populations of inflammatory cells, particularly plasma cells, lymphocytes and macrophages, as well as locations of fibrosis and necrosis without cellular anaplasia or atypical mitoses. Despite subsequent reports in the references, hepatic IPT remains difficult to diagnose; while posing major issues specifically for its differential diagnosis compared with that of other various benign diseases and malignant hepatic tumors. Histopathological findings are always a requisite for confirming the diagnosis, particularly given that the pathogenesis of IPT remains ambiguous to date. Hepatic IPT is a heterogeneous entity in terms of its clinical features, pathological findings, and pathogenesis. Once the diagnosis is confirmed, however, needless surgery such as wedge resection and lobectomy should be avoided. Here, we discuss the heterogeneity of hepatic IPT, its clinical features, pathological findings, and pathogenesis, and describe its differential diagnosis.
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Affiliation(s)
- Soo Ryang Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Japan;
| | - Soo Ki Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Japan;
| | - Yu-ichiro Koma
- Department of Pathology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Motoko Sasaki
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
| | - Akira Asai
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
| | - Hiroki Nishikawa
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
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2
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Rajamanickam Chandrasekaran K, Aftab S, Al Jajeh I, Kumar R. A Case of Inflammatory Pseudotumour Masquerading as Hepatocellular Carcinoma. Cureus 2023; 15:e45897. [PMID: 37753063 PMCID: PMC10518897 DOI: 10.7759/cureus.45897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 09/28/2023] Open
Abstract
Inflammatory pseudotumors (IPTs) of the liver can mimic malignant lesions. As the name implies, they are usually associated with an inflammatory process and usually regress with the treatment of the underlying pathology. We report a case of a 67-year-old female who presented with right upper quadrant pain, deranged liver enzymes, elevated tumor markers [alpha-fetoprotein (AFP) and CA 19-9], and a large liver mass on imaging, suspected to be hepatocellular carcinoma (HCC). She was eventually diagnosed with IPT complicating the liver inflammation due to autoimmune hepatitis (AIH). She responded well to treatment with steroids and immunosuppressive therapy.
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Affiliation(s)
| | - Syed Aftab
- Diagnostic Radiology, Sengkang General Hospital, Singapore, SGP
| | | | - Rajneesh Kumar
- Gastroenterology and Hepatology, Singapore General Hospital, Singapore, SGP
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3
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Li YY, Zang JF, Zhang C. Laparoscopic treatment of inflammatory myofibroblastic tumor in liver: A case report. World J Clin Cases 2022; 10:11853-11860. [PMID: 36405255 PMCID: PMC9669864 DOI: 10.12998/wjcc.v10.i32.11853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor in the liver (IMTL) is a rare borderline mesenchymal tumor. Neither clinical symptoms nor laboratory tests have absolute specificity for the diagnosis of IMTL, and imaging also lacks obvious specificity. Although there are sporadic reports of recurrence after surgical treatment, surgical resection is the mainstay of treatment.
CASE SUMMARY A 29-year-old man complained of general weakness, slight discomfort in the upper abdomen, with a history of upper respiratory tract infection for 1 wk before admission. Plain and enhanced upper abdominal magnetic resonance imaging showed a mass in liver segments II and III (48 mm × 53 mm). He was treated by laparoscopic left lateral segmentectomy. Postoperative pathological examination with hematoxylin and eosin staining suggested that the mass in liver segments II and III was IMTL. During 21 mo postoperative follow-up, no obvious residual or recurrent lesions were observed.
CONCLUSION There is a risk of malignant degeneration in IMTL. The principal choice of treatment is laparoscopic left lateral segmentectomy.
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Affiliation(s)
- Yang-Yang Li
- Department of Hepatobiliary Surgery, Taizhou People’s Hospital, The Fifth Affiliated Hospital of Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China
| | - Jin-Feng Zang
- Department of Hepatobiliary Surgery, Taizhou People’s Hospital, The Fifth Affiliated Hospital of Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China
| | - Chi Zhang
- Department of Hepatobiliary Surgery, Taizhou People’s Hospital, The Fifth Affiliated Hospital of Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China
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4
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Park JW, Han SH, Kim DK. [Inflammatory Myofibroblastic Tumor Misdiagnosed as Intrahepatic Cholangiocarcinoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022; 79:41-44. [PMID: 35086972 DOI: 10.4166/kjg.2021.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/28/2021] [Accepted: 11/28/2021] [Indexed: 11/03/2022]
Abstract
An inflammatory myofibroblastic tumor (IMT) is a rare tumor that is currently classified as an intermediate cancer according to the World Health Organization classification system. The pathophysiology of its occurrence is still unknown. Imaging tests, such as CT or MRI, can be helpful in diagnosis, but the final diagnosis is confirmed by a pathological examination through a biopsy and immunohistochemistry stain. The patient, in this case, presented an asymptomatic intrahepatic mass discovered incidentally on an imaging examination. Initially, intrahepatic cholangiocarcinoma was suspected, but she was finally diagnosed with IMT through a histological examination after a liver resection.
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Affiliation(s)
- Ji Weon Park
- Department of Gastroenterology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Song Hee Han
- Department of Pathology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Dong Kyun Kim
- Department of Gastroenterology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
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5
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Geiselmann MT, Acampa DJ, Melamed J, Arif F, Takabe K, Seitelman E, Datta R, Gunasekaran G, Takahashi H. Immunoglobulin G4-Negative Inflammatory Pseudotumors of the Pancreas. World J Oncol 2022; 12:240-245. [PMID: 35059084 PMCID: PMC8734500 DOI: 10.14740/wjon1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 11/11/2022] Open
Abstract
Inflammatory pseudotumor (IPT) can occur in any organ, but rarely shows pancreatic involvement. While surgical excision has been recommended as the primary treatment for IPT of the pancreas in the past, some authors suggest observation while medical management often results in regression. Corticosteroids, nonsteroidal anti-inflammatory drugs and immunosuppressive therapy have been used to treat IPTs. Spontaneous regression has also been reported in IPT managed without surgical intervention. A 62-year-old female was evaluated for worsening abdominal pain and a mass in the neck of the pancreas that was identified on ultrasound. Further imaging with magnetic resonance imaging revealed a pancreatic mass with dilated pancreatic duct and an atrophic parenchyma of the pancreatic neck. Her serum tumor markers were not elevated. As this lesion appeared to be resectable pancreatic cancer based on cross-sectional imaging, no biopsy was performed prior to surgical resection. Distal pancreatectomy and splenectomy was recommended and the patient desired to proceed. Her recovery was uneventful with no postoperative complications, including pancreatic fistula. Final pathology revealed a lesion consistent with the diagnosis of immunoglobulin G4 (IgG4)-negative IPT without neoplasm. IPT of the pancreas is a difficult entity to diagnose and treat due to clinical and imaging characteristics closely resembling pancreatic adenocarcinoma. Biopsy with immunohistochemical analysis can be useful in diagnosing IPT; however, symptomatic lesions and concerning findings on cross-sectional imaging may warrant more definitive surgical intervention.
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Affiliation(s)
- Matthew T Geiselmann
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Daniel J Acampa
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Joshua Melamed
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Farzana Arif
- Department of Pathology, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA.,Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Eric Seitelman
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Rajiv Datta
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Ganesh Gunasekaran
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA.,Department of Surgery, Division of HPB Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Hideo Takahashi
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
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Fibrohistiocytic Variant of Hepatic Pseudotumor: An Antibiotic Responsive Tumefactive Lesion. Am J Surg Pathol 2021; 45:1314-1323. [PMID: 34334689 DOI: 10.1097/pas.0000000000001767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Inflammatory pseudotumor is a term used to designate inflammation-rich tumefactive lesions. Following the exclusion of specific entities such as IgG4-related disease and other neoplastic entities previously included in this entity, the majority of hepatic pseudotumors show a prominent fibrohistiocytic inflammatory reaction and have been previously categorized as fibrohistiocytic variant of hepatic pseudotumor (FHVHPT). The goal of this study was to examine the clinical, radiologic, histologic, and etiologic aspects of this entity. After excluding neoplastic diseases, we identified 30 patients with FHVHPT from 3 institutions between 2009 and 2019. We extracted demographic and clinical data, liver function tests as well as culture results and radiologic information. Hematoxylin and eosin-stained slides were reviewed for pattern of inflammation as well as its cellular composition. Immunohistochemistry for IgG4 and IgG was performed in all cases. The mean age of the 30 lesions characterized as FHVHPT was 56 years (range: 23 to 79 y). Nineteen patients showed solitary lesions; 11 were multiple. The mean size of the lesion was 3.8 cm (range: 1 to 7.5 cm). On imaging, a neoplastic process or metastasis was the leading diagnostic consideration (n=15, 50%). The most common symptom was abdominal pain (n=14/30); 8 patients presented with symptoms compatible with an infectious process, including fever. The inflammatory infiltrate was dominated by lymphocytes and plasma cells, and in most cases, a prominent histiocytic infiltrate (22/30). Neutrophils were identified in 12 cases, with microabscess noted in 8. Storiform pattern of fibrosis was seen in 14/30 cases; obliterative phlebitis was not identified. Culture identified a microorganism in 4 of 9 cases evaluated. The mean IgG4 count was 9.3 per HPF (range: 0 to 51) with 9 of the 26 (35%) biopsies showing >10 IgG4 positive plasma cells per HPF. The mean IgG4 to IgG ratio was 8% (range: 8% to 46%). A hepatectomy was performed in 4 cases. On broad spectrum antibiotics (n=14) the lesions either resolved or decreased in size. Eight patients did not receive specific therapy, nevertheless, the lesion(s) resolved spontaneously in 6 cases, remained stable or decreased in size in 2 cases. Notably, none of these patients showed evidence of a hepatic recurrence. FHVHPT, a tumefactive lesion that mimics hepatic neoplasia, is histologically characterized by a fibrohistiocytic infiltrate. In the majority of patients FHVHPT represents the organizing phase of hepatic abscess and can be successfully managed with antibiotic therapy.
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Jang EJ, Kim KW, Kang SH, Pak MG, Han SH. Inflammatory myofibroblastic tumors arising from pancreas head and peri-splenic area mimicking a malignancy. Ann Hepatobiliary Pancreat Surg 2021; 25:287-292. [PMID: 34053934 PMCID: PMC8180395 DOI: 10.14701/ahbps.2021.25.2.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are a rare chronic inflammatory disease with unclear pathogenesis and pathological features that are not those of a malignant tumor. It is difficult to differentially diagnose them without surgical excision because of their unpredictable clinical behavior, which ranges from benign to locally invasive aggressiveness. We report two cases of IMTs that were diagnosed after surgery. In one case, the IMT originated in peri-splenic area in a 63-year-old female patient. The other case involved a 48-year-old female patient who suffered from an IMT of the head of the pancreas. Both of these cases did not require further treatment based on histological findings, and there has been no evidence of recurrence or metastasis so far. These cases show that the primary choice for the exact diagnosis and proper treatment of IMTs is complete surgical resection.
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Affiliation(s)
- Eun Jeong Jang
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Kwan Woo Kim
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Sung Hwa Kang
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Min Gyoung Pak
- Department of Pathology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Song Hee Han
- Department of Pathology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
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Oh K, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Hong SM. Clinicopathological features and post-resection outcomes of inflammatory pseudotumor of the liver. Ann Hepatobiliary Pancreat Surg 2021; 25:34-38. [PMID: 33649252 PMCID: PMC7952659 DOI: 10.14701/ahbps.2021.25.1.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 01/17/2023] Open
Abstract
Backgrounds/Aims Hepatic inflammatory pseudotumor (HIPT) is a rare disease characterized by chronic infiltration of inflammatory cells and area of fibrosis. The objective of this retrospective observational study was to investigate clinicopathological features and outcomes of patients who underwent hepatic resection (HR) for HIPT. Methods From 2009 to 2018, seven patients with HIPT underwent HR, accounting for 0.06% of 11,979 adults who underwent HR at our center. Results These seven patients included five men and two women. Their mean age was 62.3±11.6 years. In four patients with hepatitis B virus (HBV)-associated liver cirrhosis or chronic hepatitis, liver masses were suspected of hepatocellular carcinoma (HCC) or combined HCC-cholangiocarcinoma based on imaging studies. In three patients without HBV infection, two patients were suspected of HCC, for whom liver biopsy was not performed. One patient was suspected of liver abscess or HIPT, for whom percutaneous liver biopsy was performed and the mass was diagnosed with HIPT. However, this patient underwent HR owing to abdominal pain. No patient presented with abnormally elevated levels of alpha-fetoprotein, protein induced by vitamin K absence or antagonist-II, or CA19-9. During a mean follow-up period of 76.4±34.8 months, no patient experienced recurrence of HIPT. Conclusions HIPT, a rare form of liver disease, is often misdiagnosed as malignant liver tumor. Active histological diagnosis is warranted for patients with suspected HIPT to avoid unnecessary operation. HR can be indicated in case of diagnostic ambiguity of HIPT or under a clinical diagnosis of malignant liver tumor.
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Affiliation(s)
- Kibong Oh
- Department of Surgery, Anyang SAM Hospital, Anyang, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hayashi M, Fujita M, Abe K, Takahashi A, Muto M, Ishigame T, Okada R, Marubashi S, Ohira H. Intratumor Abscess in a Posttraumatic Hepatic Inflammatory Pseudotumor Spreading Out of the Liver. Intern Med 2021; 60:235-240. [PMID: 32893230 PMCID: PMC7872811 DOI: 10.2169/internalmedicine.5166-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 45-year-old woman with abdominal pain after minor trauma was referred to our hospital. Computed tomography (CT) showed a hypovascular tumor in the left liver lobe. A tumor biopsy revealed granuloma, although no findings indicated malignancy or infection. A follow-up imaging study showed spread of the hepatic tumor. Her abdominal pain worsened after a second minor trauma. CT revealed an intratumor abscess, and pus overflowed from the patient's umbilicus. The abscess was improved by antibiotics and drainage therapy. In this case, unusual imaging findings and an atypical disease course of a hepatic inflammatory pseudotumor were observed.
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Affiliation(s)
- Manabu Hayashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Masashi Fujita
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Kazumichi Abe
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Makoto Muto
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Japan
| | - Ryo Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
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Filips A, Maurer MH, Montani M, Beldi G, Lachenmayer A. Inflammatory myofibroblastic tumor of the liver: A case report and review of literature. World J Hepatol 2020; 12:170-183. [PMID: 32685109 PMCID: PMC7336290 DOI: 10.4254/wjh.v12.i4.170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumors of the liver (IMTL) are extremely rare neoplasms and very little is known about their clinical presentation, pathogenesis, and biological behavior. Due to their absolute rarity, it is almost impossible to obtain a definite diagnosis without histological examination. Because of their intermediate biological behavior with the risk for local recurrence and metastases, surgical resection is recommend whenever IMTL is suspect.
CASE SUMMARY We herein present a case of an otherwise healthy 32-year-old woman who presented with intermittent fever, unclear anemia, malaise and right flank pain 4 mo postpartum. The liver mass in segment IVa/b was highly FDG avid in the positron emission tomography-computed tomography. Hepatic resection was performed achieving a negative resection margin and an immediate resolution of all clinical symptoms. Histological analysis diagnosed the rare finding of an inflammatory myofibroblastic tumor of the liver and revealed cytoplasmic anaplastic lymphoma kinase expression by immunohistochemistry. Twelve months follow-up magnetic resonance imaging showed no recurrence and no metastases in the fully recovered patient.
CONCLUSION IMTLs are extremely rare and difficult to diagnose. Due to their intermediate biological behavior, surgical resection should be perform whenever feasible and patients should be followed-up in order to detect recurrence and metastasis as early as possible.
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Affiliation(s)
- Alexandra Filips
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Martin H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Matteo Montani
- Institute of Pathology, Inselspital, University Hospital, University Bern, Bern 3010, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
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Kwag MH, Park JY, Jeong HW, Han JY, Lim JH, Kim YS, Park JW. Overlooked and Challenging Encounters–Inflammatory Pseudotumors in the Abdomen and Pelvis: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1121-1133. [PMID: 36238032 PMCID: PMC9431880 DOI: 10.3348/jksr.2019.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 11/15/2022]
Abstract
Inflammatory pseudotumors (IPTs) are uncommon, mass-forming lesions, predominantly involving the lung and orbit. Although the incidence of IPTs is rare in the abdomen and pelvis, they can be encountered as enhancing, soft-tissue lesions, mimicking malignancy or fibrosclerosing disease. Generally, they exhibit a wide range of nonspecific imaging features in various organs. Preoperative imaging diagnosis of IPTs in appropriate clinical settings may help determine proper patient management. In this article, we review radiologic findings of IPTs in the abdominopelvic cavity, including the liver, spleen, kidney, gastrointestinal tract, mesentery, pelvis, and retroperitoneum.
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Affiliation(s)
- Min Ha Kwag
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jin Young Park
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ji Yeon Han
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jong Heon Lim
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Seon Kim
- Department of Radiology, Yeungnam University Hospital, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jung Won Park
- Department of Radiology, Gimhaebokum Hospital, Gimhae, Korea
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12
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Patel H, Nanavati S, Ha J, Shah A, Baddoura W. Spontaneous Resolution of IgG4-Related Hepatic Inflammatory Pseudotumor Mimicking Malignancy. Case Rep Gastroenterol 2018; 12:311-316. [PMID: 30022921 PMCID: PMC6047548 DOI: 10.1159/000490100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 12/16/2022] Open
Abstract
Hepatic inflammatory pseudotumor (IPT) is characterized by a well-circumscribed benign tumor mimicking or often mistaken for a malignant lesion. A 48-year-old male presented to the hospital with complaints of epigastric pain, with initial laboratory findings showing mildly elevated alkaline phosphatase (140 U/L) with normal AST, ALT, bilirubin, and lipase, a CD4 count of 384, and an HIV viral load of > 10 million copies. The total IgG level was elevated to 2,228 mg/dL (normal IgG4 level 114 mg/dL). Contrast-enhanced MRI of the abdomen showed heterogeneous mass-like infiltration in the right lobe of the liver measuring 9.6 cm. The liver mass was biopsied which showed dense collagenous fibrosis with abundant lymphoplasmacytic infiltrates with 18 IgG4-positive plasma cells per high-power field. The patient was not given any treatment for this IPT. For more than 1 year of follow-up triple-phase CT scan of the liver was repeated, which showed no liver mass. As radiological images of hepatic IPTs, including IgG4-related hepatic IPT, mimic liver malignancy, histological analysis of the biopsy remains the cornerstone for the diagnosis. Symptomatic patients with IgG4-related hepatic IPT have shown improvement with corticosteroid use; however, spontaneous resolution has also been reported like in the present case.
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Affiliation(s)
- Hiren Patel
- Department of Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Sushant Nanavati
- Department of Internal Medicine, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Jewook Ha
- Department of Internal Medicine, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Amol Shah
- Department of Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Walid Baddoura
- Department of Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
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13
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Thampy R, Elsayes KM, Menias CO, Pickhardt PJ, Kang HC, Deshmukh SP, Ahmed K, Korivi BR. Imaging features of rare mesenychmal liver tumours: beyond haemangiomas. Br J Radiol 2017; 90:20170373. [PMID: 28766950 PMCID: PMC5963373 DOI: 10.1259/bjr.20170373] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022] Open
Abstract
Tumours arising from mesenchymal tissue components such as vascular, fibrous and adipose tissue can manifest in the liver. Although histopathology is often necessary for definitive diagnosis, many of these lesions exhibit characteristic imaging features. The radiologist plays an important role in suggesting the diagnosis, which can direct appropriate immunohistochemical staining at histology. The aim of this review is to present clinical and imaging findings of a spectrum of mesenchymal liver tumours such as haemangioma, epithelioid haemangioendothelioma, lipoma, PEComa, angiosarcoma, inflammatory myofibroblastic tumour, solitary fibrous tumour, leiomyoma, leiomyosarcoma, Kaposi sarcoma, mesenchymal hamartoma, undifferentiated embryonal sarcoma, rhabdomyosarcoma and hepatic metastases. Knowledge of the characteristic features of these tumours will aid in guiding the radiologic diagnosis and appropriate patient management.
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Affiliation(s)
- Rajesh Thampy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Hyunseon C Kang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sandeep P Deshmukh
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kareem Ahmed
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brinda Rao Korivi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Berumen J, McCarty P, Mo J, Newton K, Fairbanks T, Mekeel K, Hemming A. Combined liver transplant and pancreaticoduodenectomy for inflammatory hilar myofibroblastic tumor: Case report and review of the literature. Pediatr Transplant 2017; 21. [PMID: 28000317 DOI: 10.1111/petr.12846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 12/14/2022]
Abstract
IMT, previously known as IPT, is a relatively rare tumor that was originally described in the lungs, but case reports have reported the tumor in almost every organ system. Surgical resection is typically the mainstay of therapy; however, tumors have also been shown to respond to chemotherapy or anti-inflammatory therapy and some have spontaneously regressed. We present a literature review and case report representing the first documentation to date of liver transplant combined with PD for surgical resection of a myofibroblastic tumor non-responsive to medical therapy.
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Affiliation(s)
| | - Patrick McCarty
- University of California San Diego - Surgery, La Jolla, CA, USA
| | - Jun Mo
- University of California San Diego - Surgery, La Jolla, CA, USA
| | - Kimberly Newton
- University of California San Diego - Surgery, La Jolla, CA, USA
| | | | - Kristin Mekeel
- University of California San Diego - Surgery, La Jolla, CA, USA
| | - Alan Hemming
- University of California San Diego - Surgery, La Jolla, CA, USA
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15
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Yamakawa H, Sekine A, Yamanaka Y, Sadoyama S, Baba T, Hagiwara E, Okudela K, Ogura T. Pathologically Proven Spontaneous Remission of IgG4-related Retroperitoneal Fibrosis. Intern Med 2017; 56:1867-1871. [PMID: 28717084 PMCID: PMC5548681 DOI: 10.2169/internalmedicine.56.7996] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Some forms of idiopathic retroperitoneal fibrosis (RF) have recently been considered to be a part of the spectrum of immunoglobulin G4 (IgG4)-related disease. This case report is the first description of a spontaneous remission in a patient with pathologically proven IgG4-related RF. Although the pathogenesis and long-term disease behavior of IgG4-related RF remains unknown, we believe that an initial assessment consisting of only careful monitoring might be one important strategy, especially in asymptomatic IgG4-related RF patients without nephropathy, while carefully monitoring these patients for the risk of recurrence.
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Affiliation(s)
- Hideaki Yamakawa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Yumie Yamanaka
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Japan
| | - Shinko Sadoyama
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Koji Okudela
- Department of Pathobiology, Yokohama City University Graduate School of Medicine, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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16
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Obana T, Yamasaki S, Nishio K, Kobayashi Y. A case of hepatic inflammatory pseudotumor protruding from the liver surface. Clin J Gastroenterol 2015; 8:340-4. [PMID: 26412330 DOI: 10.1007/s12328-015-0605-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/05/2015] [Indexed: 12/17/2022]
Abstract
We report a case of a resected hepatic inflammatory pseudotumor (IPT) protruding from the liver surface. A 69-year-old male with diabetes mellitus was admitted to hospital for investigation of an hepatic mass. An irregularly shaped, low-echoic mass measuring 21 × 18 mm was identified by ultrasound in S6. On computed tomography, the tumor appeared to be growing extrahepatically. After contrast enhancement, the lesion showed persistent peripheral enhancement, while the central part was hypoenhanced. On T2-weighted magnetic resonance imaging (MRI), the central portion of the lesion was hyperintense compared with the periphery. EOB-enhanced MRI revealed the mass to be being hypointense in contrast to the surrounding liver parenchyma in the hepatobiliary phase. On diffusion-weighted images, the lesion was hyperintense. Percutaneous biopsy was not attempted to avoid tumor cell dissemination. The patient underwent partial hepatectomy because of suspected malignancy. Histopathological examination of the resected specimen revealed fibrotic tissue and abundant vessels in the periphery, while a massive infiltration of inflammatory cells and fewer vessels were observed in the center. The patient was finally diagnosed with hepatic IPT of the fibrohistiocytic type.
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Affiliation(s)
- Takashi Obana
- Department of Gastroenterology, Kyojinkai Komatsu Hospital, 11-6 Kawakatsu-cho, Neyagawa City, Osaka Prefecture, 572-8567, Japan.
| | - Shuuji Yamasaki
- Department of Gastroenterology, Kyojinkai Komatsu Hospital, 11-6 Kawakatsu-cho, Neyagawa City, Osaka Prefecture, 572-8567, Japan
| | - Kazushi Nishio
- Department of Surgery, Kyojinkai Komatsu Hospital, Neyagawa, Japan
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17
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Conservative treatment of hepatic inflammatory pseudotumor. Cir Esp 2015; 94:422-4. [PMID: 26238429 DOI: 10.1016/j.ciresp.2015.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/17/2015] [Accepted: 05/22/2015] [Indexed: 01/03/2023]
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18
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Zhang Y, Lu H, Ji H, Li Y. Inflammatory pseudotumor of the liver: A case report and literature review. Intractable Rare Dis Res 2015; 4:155-8. [PMID: 26361568 PMCID: PMC4561246 DOI: 10.5582/irdr.2015.01021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 12/21/2022] Open
Abstract
Reported here is the case of a 55-year-old man who had tarry stools for 3 days before he was seen at this Department. The man had weight loss and an intermittent fever for 3 months prior. Histopathology revealed an inflammatory pseudotumor of the liver. This case is reported here along with a review of the literature. Nine days after surgery, the patient passed bright red blood (150 mL) in the stool with no clear trigger. A colonoscopy a month later revealed no abnormalities. This is a rare report of an inflammatory pseudotumor featuring intractable bleeding. An inflammatory pseudotumor of the liver is a rare condition, and differentiating this pseudotumor from hepatic space-occupying lesions is crucial. An inflammatory pseudotumor of the liver may spontaneously regress and mimic other liver tumors. The treatment of choice for this pseudotumor is still surgical resection, and this is especially true for patients with severe symptoms or an indeterminate diagnosis.
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Affiliation(s)
- Yafei Zhang
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Hongwei Lu
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Hong Ji
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Yiming Li
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
- Address correspondence to: Dr. Yiming Li, Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 157 West 5th Road, Xi'an 710004, People's Republic of China. E-mail:
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19
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Inflammatory Myofibroblastic Tumor of Liver Masquerading as Focal Nodular Hyperplasia in a Patient with Non-Cirrhotic Portal Hypertension and Biliary Pancreatitis. Indian J Surg Oncol 2015; 7:110-4. [PMID: 27065695 DOI: 10.1007/s13193-015-0381-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 02/03/2015] [Indexed: 01/20/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare lesion of undetermined pathogenesis characterized by proliferation of spindled myofibroblast cells in a collagenized inflammatory background. It is usually benign but may show local infiltration or, in rare cases, metastasis. IMT has been observed in almost all solid organs; however, involvement of liver is exceptional. Its symptoms and radiological findings can mimic malignancy and pose diagnostic difficulties. The authors report the case of a 43-year-old woman with non-cirrhotic portal hypertension and gall stone induced acute pancreatitis having a mass in the right lobe of the liver which was initially diagnosed as focal nodular hyperplasia on imaging but proved to be inflammatory myofibroblastic tumor on pathological and immunohistochemical examination. The lesion resolved with conservative management without the need for surgical intervention.
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20
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Bae SK, Abiru S, Kamohara Y, Hashimoto S, Otani M, Saeki A, Nagaoka S, Yamasaki K, Komori A, Ito M, Fujioka H, Yatsuhashi H. Hepatic inflammatory pseudotumor associated with xanthogranulomatous cholangitis mimicking cholangiocarcinoma. Intern Med 2015; 54:771-5. [PMID: 25832940 DOI: 10.2169/internalmedicine.54.2623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Inflammatory pseudotumor (IPT) is a rare benign condition often misdiagnosed as malignancy. An 80-year-old man was referred to our clinic for an asymptomatic hepatic mass detected on plain abdominal CT. Abdominal ultrasonography identified the lesion as a poorly defined hypoechoic mass. Although a liver biopsy did not provide any evidence of malignancy, imaging modalities suggested a diagnosis of cholangiocarcinoma. The patient underwent left lobectomy, and the pathological findings were consistent with the features of xanthogranulomatous cholangitis. This case is the first report of hepatic IPT originating from xanthogranulomatous cholangitis without symptoms and illustrates the importance of obtaining a preoperative diagnosis in order to avoid a misdiagnosis of malignant tumor.
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Affiliation(s)
- Sung Kwan Bae
- Clinical Research Center, National Hospital Organization (NHO) Nagasaki Medical Center, Japan
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21
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Zhao JJ, Ling JQ, Fang Y, Gao XD, Shu P, Shen KT, Qin J, Sun YH, Qin XY. Intra-abdominal inflammatory myofibroblastic tumor: Spontaneous regression. World J Gastroenterol 2014; 20:13625-13631. [PMID: 25309095 PMCID: PMC4188916 DOI: 10.3748/wjg.v20.i37.13625] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/01/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammatory myofibroblastic tumors are usually treated by surgical resection. We herein report two cases of intra-abdominal inflammatory myofibroblastic tumors that were unresectable and underwent spontaneous regression without any treatment. Our case report and literature review show that regression is more common in the middle-aged and older male populations. Abdominal discomfort and fever were the most common symptoms, but the majority of patients had no obvious physical signs. There was no specific indicator for diagnosis. The majority of the lesions regressed within 3 mo and nearly all of the masses completely resolved within 1 year. We conclude that the clinical characteristics of inflammatory myofibroblastic tumors are variable and, accordingly, the disease needs to be subdivided and treated on an individual basis. Surgery is always the first-line treatment; however, for those masses assessed as unresectable, conservative therapy with intense follow-up should be considered.
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22
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Inflammatory myofibroblastic tumor of the gallbladder: imaging aspects. J Med Ultrason (2001) 2014; 42:89-95. [DOI: 10.1007/s10396-014-0566-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/01/2014] [Indexed: 12/12/2022]
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23
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Kang T, Kim S, Jang K, Choi D, Choi J, Park C. Inflammatory myofibroblastic tumours of the liver: Gadoxetic acid-enhanced and diffusion-weighted MRI findings with 18F-FDG PET/CT and clinical significance of regression on follow-up. Clin Radiol 2014; 69:509-18. [DOI: 10.1016/j.crad.2013.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/24/2013] [Accepted: 12/30/2013] [Indexed: 01/17/2023]
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24
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Chang SD, Scali EP, Abrahams Z, Tha S, Yoshida EM. Inflammatory pseudotumor of the liver: a rare case of recurrence following surgical resection. J Radiol Case Rep 2014; 8:23-30. [PMID: 24967025 DOI: 10.3941/jrcr.v8i3.1459] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Inflammatory pseudotumor (IPT) of the liver is a rare, benign lesion that may be mistaken for malignancy. IPTs are difficult to diagnose due to non-specific clinical, laboratory and imaging features. We report the case of a 38-year old Asian male who presented with fatigue, weight loss and hepatomegaly. He was found to have a large hepatic IPT and underwent surgical resection; approximately two and a half years later, he developed acute cholangitis secondary to IPT recurrence. We present the imaging features of hepatic IPT using ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). We also review the literature on the diagnosis and management of this disease. The unique features of this case include the IPT's recurrence following surgical resection, large size and multiple modalities presented.
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Affiliation(s)
- Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Elena P Scali
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Zuheir Abrahams
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Susan Tha
- Department of Pathology, University of British Columbia, Vancouver, BC, Canada
| | - Eric M Yoshida
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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25
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Puri Y, Lytras D, Luong TV, Fusai GK. Rare presentation of self-resolving multifocal inflammatory pseudo-tumour of liver. World J Clin Cases 2014; 2:5-8. [PMID: 24527425 PMCID: PMC3920235 DOI: 10.12998/wjcc.v2.i1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/21/2013] [Accepted: 01/06/2014] [Indexed: 02/05/2023] Open
Abstract
Inflammatory pseudo-tumour (IPT) of the liver is a rare condition with the appearance of a tumour-like space occupying lesion. Aetiology and natural history is not known for these benign lesions, as they are commonly diagnosed as malignant lesions and frequently undergo surgical resection since spontaneous resolution is very rare. Multifocal IPT involving both lobes of liver are rarely reported. Here we report a unique case of multifocal IPT of the liver which resolved spontaneously within 5 wk period.
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26
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Park JY, Choi MS, Lim YS, Park JW, Kim SU, Min YW, Gwak GY, Paik YH, Lee JH, Koh KC, Paik SW, Yoo BC. Clinical features, image findings, and prognosis of inflammatory pseudotumor of the liver: a multicenter experience of 45 cases. Gut Liver 2013; 8:58-63. [PMID: 24516702 PMCID: PMC3916688 DOI: 10.5009/gnl.2014.8.1.58] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/07/2013] [Accepted: 05/04/2013] [Indexed: 12/23/2022] Open
Abstract
Background/Aims Inflammatory pseudotumor (IPT) of the liver is a rare disease characterized by chronic infiltration of inflammatory cells. However, the clinical characteristics and outcomes of IPT remain uncertain. Methods Clinical features, image findings, and outcomes of 55 patients with histologically proven IPT were evaluated. Results They consisted of 26 men and 19 women with median age of 65 years. Serum carcinoembryonal antigen and carbohydrate antigen 19-9 levels were normal in 42 patients (93.3%). Enhanced CT scans indicated poorly defined peripheral enhancement (82.5%) at the arterial phase and poorly defined hyperattenuating lesions with internal hypoattenuating areas at the equilibrium phase (77.0%). Gadolinium-enhancement MRI revealed poorly defined peripheral rim-like enhancement (77.8%). Ten patients underwent surgical resection and 35 were treated conservatively with or without antibiotics. No recurrence was noted after surgical resection during follow-up (1 to 48 months). In all patients who received conservative treatment, complete resolution or size reduction was noted during follow-up (1 to 192 months). Conclusions CT and MRI provide clues to the diagnosis of IPT in patients with liver masses and normal tumor markers. However, due to the lack of pathognomonic findings, the clinician's suspicion and histological diagnosis are necessary to make an accurate diagnosis of IPT.
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Affiliation(s)
- Jun Young Park
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Seok Choi
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang Won Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Yang Won Min
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Geum-Youn Gwak
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Han Paik
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Hyoek Lee
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Cheol Koh
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woon Paik
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Chul Yoo
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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27
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Hong SW, Lee WY, Chang YG, Lee B, Lee HK, Kim HK. Inflammatory myofibroblastic tumor mimicking hepatocellular carcinoma with dense lipiodol uptake. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:89-92. [PMID: 23908967 PMCID: PMC3729993 DOI: 10.4174/jkss.2013.85.2.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 11/30/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) of the liver is a very rare lesion that has radiologic similarity with malignant liver tumor. Differential diagnosis of IMT from a malignant lesion of the liver is very important because surgical resection is not mandatory for IMT. Lipiodol computed tomography is a very sensitive and specific diagnostic tool for hepatocellular carcinomas (HCC). Herein, we describe a case of IMT that had dense lipiodol uptake in the tumor and mimicked HCC. To our knowledge, previously, only one case of IMT with dense lipiodol retention has been reported.
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Affiliation(s)
- Seong Woo Hong
- Department of Surgery, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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28
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Sedlic T, Scali EP, Lee WK, Verma S, Chang SD. Inflammatory pseudotumours in the abdomen and pelvis: a pictorial essay. Can Assoc Radiol J 2013; 65:52-9. [PMID: 23830343 DOI: 10.1016/j.carj.2013.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 01/16/2013] [Accepted: 02/02/2013] [Indexed: 10/26/2022] Open
Abstract
Inflammatory pseudotumours are uncommonly encountered lesions in the abdomen and pelvis that often present with variable and nonspecific imaging features. They may mimic other more common lesions, including malignancy. Within the appropriate clinical context, inflammatory pseudotumours merit consideration in the differential diagnosis of soft-tissue masses within the abdomen and pelvis. A preoperative diagnosis of inflammatory pseudotumour, established through biopsy, may help to differentiate this benign entity from malignancy. In this article, we reviewed the imaging features of inflammatory pseudotumours of the abdomen and pelvis, including liver, spleen, bowel, retroperitoneum, kidney, bladder, uterus, and adnexa.
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Affiliation(s)
- Tony Sedlic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elena P Scali
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Wai-Kit Lee
- Department of Radiology, University of Melbourne, Victoria, Australia
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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29
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Ahn KS, Kang KJ, Kim YH, Lim TJ, Jung HR, Kang YN, Kwon JH. Inflammatory pseudotumors mimicking intrahepatic cholangiocarcinoma of the liver; IgG4-positivity and its clinical significance. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 19:405-12. [PMID: 21894477 DOI: 10.1007/s00534-011-0436-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) of the liver is a benign condition with a good prognosis. However, it is difficult to distinguish clinical and radiological findings of IPT from those of malignancies. The aims of this study are to determine the clinical, radiological, and pathological characteristics, particularly relating to the role of the autoimmune mechanism in the development of inflammatory pseudotumours (IPTs) of the liver, and to suggest appropriate diagnostic and therapeutic strategy. STUDY DESIGN The clinical, diagnostic, and pathological characteristics including IgG4 immunohistochemical stain and follow-up data of 22 IPT patients were retrospectively analyzed. RESULTS The patients were 16 men and 6 women with a mean age of 59 years. Fifteen patients (68.2%) had associated biliary diseases. Of the 16 patients treated conservatively, the masses completely resolved in 10 patients, and reduced in size in 5 patients within the first 6 months. The remaining 6 patients were treated by surgical resection. IgG4 staining of 17 tissue samples from 22 patients were negative, most of the infiltrate being of fibrohistiocytic type, whereas 4 of 5 lymphoplasmacytic cells of dominant tumors show positive staining of IgG4. Although IgG4-related sclerosing cholangitis was mostly of lymphoplasmacytic type, other histological and clinical characteristics were similar in both types of IPTs. CONCLUSIONS IPTs of the liver can be diagnosed based on radiological and pathological findings by needle biopsy. Although the lymphoplasmacytic type of IPTs seems to correspond to IgG4-related disease, as assessed by IgG4 immunohistochemical stain, its clinical significance is unknown. Although most IPTs can be resolved with conservative therapy, surgical resection should be considered in cases of uncertain biopsy result, presumed malignant lesion, combination with other pathology, or lack of response to conservative management.
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Affiliation(s)
- Keun Soo Ahn
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea
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30
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Saito M, Seo Y, Yano Y, Miki A, Morinaga Y, Itoh T, Yoshida M, Azuma T. Sonazoid-enhanced ultrasonography and Ga-EOB-DTPA-enhanced MRI of hepatic inflammatory pseudotumor: a case report. Intern Med 2012; 51:723-6. [PMID: 22466827 DOI: 10.2169/internalmedicine.51.6811] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A liver neoplasm was found in a 63-year-old man with alcoholic liver disease. Sonazoid-enhanced ultrasonography (US) showed that the neoplasm was isoechoic at the early vascular phase and hypoechoic at the post-vascular phase. Gadolinium ethoxybenzyl-diethylenetriamine-enhanced magnetic resonance imaging (MRI) showed that the neoplasm was hypointense at the hepatobiliary phase. We suspected that it was a malignant tumor. By needle biopsy, however, the neoplasm was diagnosed as an inflammatory pseudotumor (IPT). We encountered a rare case of hepatic IPT, the differential diagnosis of which was difficult to distinguish from malignant tumor. Here, we report new US and MRI findings of hepatic IPT.
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Affiliation(s)
- Masaya Saito
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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31
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A new case of spontaneous regression of inflammatory hepatic pseudotumor. Case Rep Med 2011; 2011:139125. [PMID: 21541218 PMCID: PMC3085331 DOI: 10.1155/2011/139125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Revised: 11/16/2010] [Accepted: 01/19/2011] [Indexed: 12/15/2022] Open
Abstract
Introduction. Inflammatory pseudo-tumors (IPT) of the liver are rare and difficult to diagnose, because mimicking malignant tumors. Aim. We report a case of IPT of the liver wich diagnosis was made on clinical, radiological and evolutif features. Observation. A 15-year-old man had a 4-month history of abdominal pain in the right upper quadrant with fever and cought. Two successives ultrasonographies revealed a hypoechoic lesion occuping the segment VIII with 8 cm of diametre. Physical examination was normal. Laboratory investigation showed normal blood counts, liver function test and tumoral markers. Another ultrasonography was interpretated as normal. Tomodensitometry had showon a 3-cm lesion wich enhanced later after contrast injection. A second tomodensitometry done one mounth later described a 2-cm sub capsular heaptic lesion. Discussion. On routine activiy, pre operative diagnosis of IPT of the liver is difficut, and rarely made with certitude because mimicking a malignant tumor. In our cae report here, the analysis of previous history, of clinical, biological and radiological presentation, had permittes us to pose the diagnosis of PTI of the liver and this despite the absence of histological confirmation by percutaneous biopsy.
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Yim HE, Choi BM, Rhie YJ, Yoo KH, Hong YS, Lee JW. Hepatic and pulmonary nodular lesions in pediatric urinary tract infections. Pediatr Nephrol 2011; 26:425-31. [PMID: 21170664 DOI: 10.1007/s00467-010-1706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 11/02/2010] [Accepted: 11/04/2010] [Indexed: 11/30/2022]
Abstract
One of the major goals in investigating children with urinary tract infection (UTI) is to recognize patients at risk of further UTI-related problems. This study reports the clinical features of 19 pediatric patients with UTIs in whom associated hepatic and/or pulmonary nodules were incidentally diagnosed by the imaging tests performed for the UTI. Hepatic nodules in five patients were detected on ultrasound scans, and pulmonary nodules and both hepatic and pulmonary nodules were detected in 12 and two children by dimercaptosuccinic acid scintigraphy. The mean age of the patients was 24.5 months. Vesicoureteral reflux (VUR) was detected in nine of 17 patients (52.9%), acute pyelonephritis was identified in nine of 18 patients, and renal scarring was found in 57.1% patients with pyelonephritis. On follow-up, the hepatic and/or pulmonary nodules regressed in all patients. About 85.7% of patients experienced a recurrence of UTI within 1 year. In comparison with age- and sex-matched controls with UTIs without pulmonary or hepatic nodules, the presence of VUR and the recurrence of UTI within 1 year were higher in patients with UTIs and nodules (P<0.05). The hepatic and/or pulmonary nodules identified on the ultrasound scan and by dimercaptosuccinic acid scintigraphy may provide a valuable diagnostic marker for the proper management of patients with an UTI.
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Affiliation(s)
- Hyung Eun Yim
- Department of Pediatrics, College of Medicine, Korea University, Seoul, 152-703, Korea
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Katoh M, Imamura H, Yoshino M, Aoki T, Abumiya T, Aida T. Spontaneous regression of an anterior skull base mass. J Clin Neurosci 2010; 17:786-8. [PMID: 20356749 DOI: 10.1016/j.jocn.2009.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 10/04/2009] [Indexed: 11/29/2022]
Abstract
Spontaneous regression of an intracranial mass is rare. We report a 77-year-old man with spontaneous regression of an anterior skull base mass suspected to be an inflammatory pseudotumor. The patient attended our outpatient department approximately once per month for a regular check-up following a brain stem infarction. A small mass was detected at the anterior skull base by MRI. The mass gradually grew to about 3 cm over a period of 5 years and then remained stable for 3 years. Thereafter, the mass showed spontaneous regression 8 years after it was first visible on MRI. 'Inflammatory pseudotumor' is a broad category and the natural history of these lesions is highly variable. Although the definition does include some types of malignant lesion, most masses are benign lesions that can regress spontaneously, as in our patient. A 'wait-and-see' policy is appropriate for such patients.
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Affiliation(s)
- Masahito Katoh
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Kita 22, Nishi 15, Chuou-ku, Sapporo 060-0022, Japan.
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Ganesan K, Viamonte B, Peterson M, Kono Y, Santillan C, Middleton M, Sirlin C. Capsular retraction: an uncommon imaging finding in hepatic inflammatory pseudotumour. Br J Radiol 2010; 82:e256-60. [PMID: 19934068 DOI: 10.1259/bjr/98517258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Capsular retraction is an infrequent but characteristic feature of malignant liver lesions such as hepatic metastases and intrahepatic cholangiocarcinoma. Rarely, this finding may be observed in association with benign lesions, such as atypical haemangiomas. Capsular retraction has not previously been reported in association with hepatic inflammatory pseudotumour (IPT). Hepatic IPT is an uncommon benign hepatic lesion with a good clinical prognosis. In this report, we discuss the case of a 48-year-old woman with capsular retraction secondary to multifocal hepatic inflammatory IPTs.
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Affiliation(s)
- K Ganesan
- Department of Radiology, University of California, San Diego, 92103-8226, USA
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Inflammatory pseudotumours of the liver: a spectrum of presentation and management options. Eur J Surg Oncol 2009; 35:1295-8. [PMID: 19515527 DOI: 10.1016/j.ejso.2009.04.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Revised: 03/23/2009] [Accepted: 04/02/2009] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To review the current management options in inflammatory pseudotumours via analysis of ten cases from this unit the largest experience of this pathology in a Western series. To assess the medical and operative options available for this condition and the varying outcomes and the lessons learned in this unit over the time period. RESULTS Data from the ten cases were analysed and a comprehensive review of the published literature to date has detailed 128 case reports with 215 cases of inflammatory pseudotumour of the liver. Data analysed included patient demographics, diagnostic modalities, details of treatment and eventual outcome. The data was tabulated using an Excel spreadsheet (Microsoft Excel 2004 for Mac 2004.Version 11.0). Categorical variables were compared using Pearson's chi(2) test and p values <0.05 were defined as statistically significant. Statistical analysis was performed using SPSS for Windows (Version 9.0, SPSS Inc., Chicago, IL). CONCLUSION Emphasis is placed on a preferred medical management initially for this tumour with a good prognosis coupled with regular follow up. There may be a need for surgical resection cases where diagnosis is unclear or the patient is not responding to medical treatment with progression of disease or symptoms.
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Computed tomographic and magnetic resonance features of inflammatory myofibroblastic tumor of the lung in children. ACTA ACUST UNITED AC 2009; 26:613-7. [DOI: 10.1007/s11604-008-0284-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 09/18/2008] [Indexed: 11/26/2022]
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