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Meng Y, Xie J, Liang Y, Wu M, Lu Y, Lu Q. Inflammatory myofibroblastic tumor in the liver: a case report. Front Oncol 2024; 14:1349692. [PMID: 38863636 PMCID: PMC11165177 DOI: 10.3389/fonc.2024.1349692] [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] [Received: 12/05/2023] [Accepted: 05/14/2024] [Indexed: 06/13/2024] Open
Abstract
Background Hepatic inflammatory myofibroblastic tumor (IMT) is an infrequent tumor with potential malignancy. However, it lacks specific clinical symptoms and usual imaging features. Case presentation A 34-year-old woman had a six-month history of fever and on-and-off pain in the upper right part of her abdomen that lasted for two weeks. Imaging tests revealed a liver mass initially thought to be liver malignancy, but subsequent histopathological examination after liver removal confirmed the diagnosis as hepatocellular inflammatory myofibroblastic tumor (HIMT). Conclusion Hepatic inflammatory myofibroblastic tumor (IMT) is an uncommon growth with vague clinical symptoms and lab results. Surgical removal remains the primary treatment method, resulting in favorable prognostic outcomes.
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Affiliation(s)
- Yinying Meng
- Department of Radiology, Wuzhou Gongren Hospital, Wuzhou, China
| | - Jinlan Xie
- Department of Radiology, Wuzhou Gongren Hospital, Wuzhou, China
| | - Yan Liang
- Department of Radiology, Wuzhou Gongren Hospital, Wuzhou, China
| | - Mulan Wu
- Department of Ultrasound, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Yi Lu
- Department of Pathology, Wuzhou Gongren Hospital, Wuzhou, China
| | - Qian Lu
- Department of Pathology, Wuzhou Gongren Hospital, Wuzhou, China
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2
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Patel A, Chen A, Lalos AT. Inflammatory pseudotumors in the liver associated with influenza: A case report. World J Hepatol 2023; 15:1164-1169. [PMID: 37970616 PMCID: PMC10642433 DOI: 10.4254/wjh.v15.i10.1164] [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: 08/14/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) is a rare and benign lesion that mimics malignancy and can develop in any part of the body. The pathophysiology and etiology of these quasineoplastic lesions remain unclear. CASE SUMMARY We report a case of a 65-year-old male who presented with fevers, night sweats, and unintentional weight loss following an influenza infection and was found to have multiple hepatic IPT's following an extensive work up. CONCLUSION Our case highlights the importance of considering hepatic IPT's in the differential in a patient who presents with symptoms and imaging findings mimicking malignancy shortly following a viral infection.
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Affiliation(s)
- Ankoor Patel
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States.
| | - Alexander Chen
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Alexander T Lalos
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
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3
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Pi J, Fan G, Huang Y, Wu Y. Inflammatory pseudotumor of the right lobe of liver: A case report. Asian J Surg 2023; 46:4072-4073. [PMID: 37147260 DOI: 10.1016/j.asjsur.2023.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Affiliation(s)
- Jiangyuan Pi
- Kunming Medical University, Kunming, Yunnan 650500, China
| | - Guangtao Fan
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Yilong Huang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Ying Wu
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China.
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4
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Primitivo A, Oliveira MH, Gonçalves A. IgG4-related hepatic inflammatory pseudotumour: could MRI suggest the correct diagnosis? BMJ Case Rep 2021; 14:e244572. [PMID: 34426430 PMCID: PMC8383849 DOI: 10.1136/bcr-2021-244572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 62-year-old woman, HIV positive, with a 3-week history of jaundice and elevated cholestatic enzymes. Imaging studies displayed intrahepatic biliary dilatation and a central liver lesion. Pathology described lesions of active cholangitis, lymphoplasmacytic infiltration and fibrosis, suggesting a hepatic inflammatory pseudotumour (IPT) IgG4 related. IgG4-related lymphoplasmacytic form of IPT belongs to IgG4-related diseases. We discuss the importance to include IgG4-related hepatic IPT as part of the differential diagnosis of any liver lesion, highlighting potential imaging clues that may help in establishing the correct diagnosis.
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Affiliation(s)
- Ana Primitivo
- Radiology, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Afonso Gonçalves
- Radiology, Hospital Beatriz Ângelo, Loures, Portugal
- Radiology, Hospital Garcia de Orta EPE, Almada, Portugal
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5
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Okamura Y, Nishitai R, Sasaki N, An H, Fushitani M, Ota T, Morioka M, Kawaguchi K, Konishi S, Hamasu S, Manaka D. Intrahepatic bile duct rupture associated with IgG4-related sclerosing cholangitis presenting hepatic inflammatory pseudotumor. Clin J Gastroenterol 2021; 14:1530-1535. [PMID: 34312794 DOI: 10.1007/s12328-021-01487-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/21/2021] [Indexed: 12/12/2022]
Abstract
A 67-year-old man with a low-grade fever was found to have a 25-mm diameter tumor of the left hepatic umbilical portion. The tumor was accompanied by occlusion of the left portal vein. Positron emission tomography using fluorodeoxyglucose showed that the tumor had abnormally high metabolic activity. Magnetic resonance imaging revealed the left hepatic duct segmental narrowing. There was a mild elevation in serum IgG4 (206 mg/dL). Intrahepatic cholangiocarcinoma was suspected. Instead of planned hepatectomy, the patient was forced to undergo emergency surgery for biliary panperitonitis caused by intrahepatic bile duct rupture. Intraoperative ultrasonography revealed a hypoechoic tumor-like thickened Glissonean sheath and needle biopsy was performed. Histologic examination confirmed fibrous tissue with IgG4-positive plasma cell infiltration without neoplastic proliferation. He was diagnosed with IgG4-related sclerosing cholangitis (IgG4-SC) presenting hepatic inflammatory pseudotumor. After his general condition improved, he underwent left hepatectomy. Macroscopic findings showed extreme fibrosis of the Glissonean sheath of the umbilical portion, and diffuse granular lesion aggregated in the left lateral segment. Microscopic examination confirmed chronic cholangitis and dense portal fibrosis in the umbilical portion and diffuse xanthogranulomatous inflammation. This is the first case report of spontaneous rupture of the intrahepatic bile duct in patient with IgG4-SC.
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Affiliation(s)
- Yusuke Okamura
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan.
| | - Ryuta Nishitai
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Naoya Sasaki
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Hideo An
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Masashi Fushitani
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Takano Ota
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Michina Morioka
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Kiyotaka Kawaguchi
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Sayuri Konishi
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Shinya Hamasu
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Dai Manaka
- Department of Surgery, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
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6
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John S, Shabana W, Salameh JP, McInnes MDF. Percutaneous Image-Guided Biopsy of the Spleen: Experience at a Single Tertiary Care Center. Can Assoc Radiol J 2020; 72:311-316. [PMID: 32157895 DOI: 10.1177/0846537120903692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to assess the complication rate of percutaneous image-guided biopsy of the spleen at our institution and to evaluate for variables associated with complication rate. METHODS This is a Research Ethics Board approved retrospective study of consecutive patients who underwent image-guided biopsy of the spleen at our institution from January 2010 to November 2019. Complications, imaging findings, and pathologic diagnosis were reviewed. Complications (major and minor) were classified per Society of Interventional Radiology Guidelines, and complication rate was calculated. Logistic regression was applied to determine factors associated with complications. Diagnostic yield was calculated. RESULTS In all, 55 patients (28 female) underwent splenic biopsy using ultrasound guidance. The most common indication was possible lymphoma in 41 (71.7%) patients followed by query metastasis 18 (31.5%) patients. Core biopsies (18 g/20 g) were done in 53 (92%) cases, and fine-needle aspiration (22 g) was performed in 4 (8%). The median number of samples collected was 4 (range: 2-9). The results were diagnostic in 54 cases (94.7%, 95% confidence interval [CI]: 88.7-100.0). There were 12 (21%, 95% CI: 10.1-31.9) patients with minor complications and 2 (3.5%, 95% CI: 0.0-8.4) with major complications (2 splenic bleeds requiring embolization, no splenectomy, or deaths). No variables (needle size, lesion size, and number of passes) were associated with complication rate. CONCLUSION Percutaneous image-guided biopsy of the spleen at a single tertiary care institution demonstrates major complication rate comparable to that in the literature with no variables associated with complication rate; there were no cases of splenectomy or death.
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Affiliation(s)
- Susan John
- Department of Medical Imaging, the Ottawa Hospital, Ontario, Canada.,The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ontario, Canada
| | - Wael Shabana
- Department of Medical Imaging, the Ottawa Hospital, Ontario, Canada.,Department of Radiology, 6363University of Ottawa, Ontario, Canada
| | - Jean-Paul Salameh
- The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ontario, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, the Ottawa Hospital, Ontario, Canada.,The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ontario, Canada.,Department of Radiology, 6363University of Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, 6363University of Ottawa, Ontario, Canada
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7
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Thanage R, Jain S, Sonthalia N, Udgirkar S, Chandnani S, Contractor Q, Rathi P. An Enigmatic Liver Mass in a Child. Euroasian J Hepatogastroenterol 2020; 9:104-107. [PMID: 32117700 PMCID: PMC7047306 DOI: 10.5005/jp-journals-10018-1307] [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] [Indexed: 11/23/2022] Open
Abstract
Hepatic space occupying lesions in childhood are a diagnostic challenge, as they are caused by a variety of malignant and nonmalignant disorders with a different prognosis and, of course, treatment. They are often misdiagnosed or diagnosed only after surgical resection. A 14-year-old boy presented with abdominal pain, evening-rise fever with loss of appetite and weight. The patient also developed jaundice after 2 months of above symptoms. Ultrasound of the abdomen showed an irregular infiltrative mass in segment IV of the liver. Gadobenate disodium magnetic resonance imaging done showed T1 hypointense and T2 hyperintense lesions in segment VIII of the liver with extension into porta with delayed enhancement suggestive of fibrous tumor. Liver biopsy showed extensive liver parenchymal fibrosis with a mixed inflammatory infiltrate with eosinophils. Bacterial, tubercular, and fungal culture of liver biopsy were negative. Although serum IgG4 levels were 7.88 g/L (N =1.9 g/L), IgG4 staining of liver biopsy was negative. The patient was started on prednisolone 1 mg/kg considering the diagnosis of inflammatory pseudotumor (IPT). Twenty days after starting the steroid, mass lesions were converted into multicystic abscess requiring antibiotics and pigtail drainage. On follow-up, patient had improved symptoms with mass lesions turned into small-sized abscess cavity. Hepatic IPTs are difficult to differentiate from malignant tumors, as they are rare and can have variable imaging findings. To avoid inadvertent surgery, histological confirmation of the hepatic mass is essential. Steroids should be used with caution with close follow-up to prevent iatrogenic complications, such as a chronic liver abscess.
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Affiliation(s)
- Ravi Thanage
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Nikhil Sonthalia
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Suhas Udgirkar
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Qais Contractor
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
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8
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Borch WR, Aguilera NS, Brissette MD, O'Malley DP, Auerbach A. Practical Applications in Immunohistochemistry: An Immunophenotypic Approach to the Spleen. Arch Pathol Lab Med 2019; 143:1093-1105. [PMID: 30917045 DOI: 10.5858/arpa.2018-0211-cp] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Even though immunohistochemistry is routinely used by pathologists, evaluation of immunohistochemistry in splenic lesions remains difficult for many. Classification of benign and splenic lesions often requires a combination of hematoxylin-eosin evaluation, immunophenotyping, and sometimes molecular testing. Immunohistochemical staining is essential in evaluating many splenic lesions, and requires an understanding of the normal compartments of the spleen. OBJECTIVE.— To address different immunohistochemical features used for identification and subclassification of different lesions of the spleen, as well as in the normal compartments of the spleen. DATA SOURCES.— The information outlined in this review article is based on our experiences with a variety of spleen cases, on the current World Health Organization classification of hematopoietic and lymphoid tumors, and on a review of English-language articles published during 2018. CONCLUSIONS.— Features for phenotyping normal spleen as well as a variety of splenic lesions, including littoral cell angioma and splenic marginal zone lymphoma, are discussed. Suggested immunopanels are provided to assist in the diagnosis of different lesions of the spleen.
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Affiliation(s)
- William R Borch
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
| | - Nadine S Aguilera
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
| | - Mark D Brissette
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
| | - Dennis P O'Malley
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
| | - Aaron Auerbach
- From the Department of Pathology, Walter Reed National Military Medical Center, Bethesda Maryland (Dr Borch); the Department of Hematopathology, University of Virginia, Charlottesville (Dr Aguilera); the Department of Hematopathology, Joint Pathology Center, Silver Spring, Maryland (Drs Brissette and Auerbach); and the Department of Hematopathology, NeoGenomics, Aliso Viejo, California (Dr O'Malley)
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9
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Wang S, Chen L, Cao Z, Mao X, Zhang L, Wang B. Inflammatory myofibroblastic tumor of the lumbar spinal canal: A Case Report With Literature Review. Medicine (Baltimore) 2017; 96:e6488. [PMID: 28658093 PMCID: PMC5500015 DOI: 10.1097/md.0000000000006488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
RATIONALE Inflammatory myofibroblastic tumor (IMT) is a rare type of mesenchymal tumor. IMT can arise in multiple anatomic locations. IMT of the lumbar spinal canal is exceptionally rare. PATIENT CONCERNS Here, we report the case of a 56-year-old male patient with an IMT who was in good health until 1 year prior to admission, when he began experiencing pain in both lower extremities and the lower back. INTERVENTIONS A space-occupying lesion in the lumbar canal was identified by magnetic resonance imaging and then surgically resected. DIAGNOSES Histopathological analysis of the lesion revealed a composition of mucous edema, inflammatory cells, collagenous fibers, and spindle cells that were diffuse and positive for smooth muscle actin and CD68; focal positive for vimentin and desmin; and negative for CD34 (marker of vascular endothelial cells), CD21, CD23, CD35, S-100, Epstein-Barr virus infection, Ki-67, and anaplastic lymphoma kinase. Thus, the diagnosis was an IMT of the lumbar canal. OUTCOMES In the spinal canal, IMT should be considered in the evaluation of tumors although it is a very rare diagnosis. It is a benign lesion, but it has potential for invasion and recurrence. LESSONS There are no characteristic imaging features of these tumors, but they can be addressed by complete surgical excision. Patients with these lesions should undergo frequent long-term follow-up to detect and address recurrence.
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Affiliation(s)
- Shanshan Wang
- Shandong Medical Imaging Research Institute, Shandong University
- Department of Radiology, Affiliated Hospital of Binzhou Medical University
- Medical Imaging Research Institute, Binzhou Medical University
| | - Liang Chen
- Department of Radiology, Affiliated Hospital of Binzhou Medical University
| | - Zhang Cao
- Department of Pathology, Affiliated Hospital of Binzhou Medical University, China
| | - Xijin Mao
- Department of Radiology, Affiliated Hospital of Binzhou Medical University
- Medical Imaging Research Institute, Binzhou Medical University
| | - Lin Zhang
- Department of Radiology, Affiliated Hospital of Binzhou Medical University
| | - Bin Wang
- Medical Imaging Research Institute, Binzhou Medical University
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10
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Christ JBM, Tannapfel A, Kukuk G, Schlottmann K, Straßburg C, Schneidewind A. [A 59-year-old woman with upper abdominal pain and fever]. Internist (Berl) 2017; 58:1090-1096. [PMID: 28555378 DOI: 10.1007/s00108-017-0255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A 59-year-old woman suffered from fever and upper abdominal pain. The computed tomography (CT) scan revealed a liver lesion. Conventional imaging techniques (CT, magnetic resonance imaging, contrast-enhanced ultrasonography) did not allow for a consistent diagnosis. Fine needle biopsy of the liver lesion was performed. Histologically, fibrotic inflammation was found and an inflammatory pseudotumor (IPT) diagnosed. Despite treatment with steroids and antibiotics, the size of the IPT increased; thus, surgical resection was necessary. In case of fever of unknown origin, IPT should be considered as a potential diagnosis.
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Affiliation(s)
- J B M Christ
- Klinik für Gastroenterologie, Diabetologie und Innere Medizin, Krankenhaus Porz am Rhein gGmbH, Urbacher Weg 19, 51149, Köln, Deutschland.
| | - A Tannapfel
- Institut für Pathologie, Universität Bochum, Bochum, Deutschland
| | - G Kukuk
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - K Schlottmann
- Klinik für Gastroenterologie, Katharinen-Hospital Unna, Unna, Deutschland
| | - C Straßburg
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn, Deutschland
| | - A Schneidewind
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn, Deutschland
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11
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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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12
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Inflammatory Pseudotumor of the Liver with Escherichia coli in the Sputum. Case Rep Med 2015; 2015:249210. [PMID: 26347780 PMCID: PMC4549540 DOI: 10.1155/2015/249210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/19/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022] Open
Abstract
Inflammatory pseudotumor is a nonmalignant lesion that mimics malignant lesions and has been reported to occur at various sites throughout the body. Though it has been reported as a reaction to infection, the true etiology of the lesion is unknown. In this report, we present the case of a patient with a liver lesion of unknown origin. Through a series of imaging studies, we were able to observe the locally aggressive nature of this lesion as it rapidly eroded into the lung. Sputum cultures showed growth of E. coli, indicating E. coli infection as a possible etiology of this lesion. Pathology was consistent with inflammatory pseudotumor.
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13
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ZHANG TIAN, YUAN YAWEI, REN CHEN, DU SHASHA, CHEN JIARONG, SUN QUANQUAN, LIU ZHENGJUN. Recurrent inflammatory myofibroblastic tumor of the inguinal region: A case report and review of the literature. Oncol Lett 2015; 10:675-680. [PMID: 26622552 PMCID: PMC4509014 DOI: 10.3892/ol.2015.3297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 04/24/2015] [Indexed: 12/17/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) of the inguinal region are exceptionally rare. The current study reported the case of a 49 year-old male patient with IMT, who presented with a fever, night sweats, anorexia, loss of weight and frequent urination. Computed tomography (CT) revealed a lesion occupying the soft tissue of the right inguinal region and surgery was performed to resect the lesion. Histopathological analysis of the lesion revealed a composition of spindle and inflammatory cells, including plasma cells and lymphocytes. In addition, immunohistochemical analysis demonstrated that the tumor cells were positive for CD34, vimentin, actin, Ki-67, B cell lymphoma-2, CD99, epithelial membrane antigen and CD38; however, tumor cells were negative for CD117, desmin, anaplastic lymphoma kinase and creatine kinase. Thus, the patient was diagnosed with IMT and was advised to return for regular follow-up appointments. Subsequently, the patient developed a local recurrence 12 months following the initial surgery. Of note, the histopathological characteristics of the recurrent lesions were consistent with those of the initial specimen. Thus, a second surgery was performed, followed by fractionated radiotherapy (FRT). At 3 and 6 months following the FRT, magnetic resonance imaging scans did not indicate tumor recurrence or metastasis. In conclusion, surgical excision is the current recommended treatment for IMT; however, for cases similar to that of the current study, which are not successfully controlled by surgical excision, radiotherapy should be considered and long-term follow-up is essential.
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Affiliation(s)
- TIAN ZHANG
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
| | - YAWEI YUAN
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - CHEN REN
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - SHASHA DU
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - JIARONG CHEN
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - QUANQUAN SUN
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - ZHENGJUN LIU
- Department of Vascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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14
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Palomeque Jiménez A, Reyes Moreno M, Calzado Baeza S, Ranea Jimena SA, Robayo Soto PS. Detection of Epstein–Barr Virus in an Inflammatory Myofibroblastic Tumor of the Spleen (Inflammatory Pseudotumor). ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.cireng.2015.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Onieva-González FG, Galeano-Díaz F, Matito-Díaz MJ, López-Guerra D, Fernández-Pérez J, Blanco-Fernández G. [Inflammatory pseudotumour of the liver. Importance of intra-operative histopathology]. CIR CIR 2015; 83:151-5. [PMID: 25986975 DOI: 10.1016/j.circir.2015.04.012] [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: 07/26/2013] [Accepted: 02/18/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inflammatory pseudotumour is a rare entity, considered benign, and characterised by inflammatory cell mesenchymal proliferation. CLINICAL CASE The case is presented 70 year-old man with fever of unknown origin syndrome. He was diagnosed with liver abscesses (one segment IV, adjacent to gallbladder fundus and segment VI), who progressed slowly after antibiotic treatment. In the absence of a diagnosis, although fine needle puncture-aspiration and different imaging tests were performed, elective surgery was decided. The intra-operative histopathology reported the existence of an inflammatory pseudotumour. CONCLUSIONS Inflammatory pseudotumours are clinically classified into different types according to their aetiology, varying therapeutic management based on the same. It is very difficult to diagnose because of the absence of symptoms, blood disorders, or specific radiological findings. Definitive diagnosis often requires histopathological confirmation, in most cases by percutaneous liver puncture, but sometimes exploratory laparotomy or even performing a hepatectomy for confirmation is necessary. The natural history of inflammatory pseudotumour is its regression; thus conservative management may be used through regular checks until resolution, or can be treated with antibiotics, anti-inflammatories and even corticosteroids. Surgical resection is indicated for persistent unresolved systemic symptoms despite medical treatment, in those situations where growth is evident, with or without symptoms, when involving the hepatic hilum, and finally, in case where the possibility of malignancy cannot be ruled out.
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Affiliation(s)
| | - Francisco Galeano-Díaz
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
| | - María José Matito-Díaz
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
| | - Diego López-Guerra
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
| | - Juana Fernández-Pérez
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
| | - Gerardo Blanco-Fernández
- Servicio de Cirugía Hepatobiliopancreática y de Trasplante Hepático, Hospital Infanta Cristina, Badajoz, España
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16
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Huang Y, Li LP, Wang J, Lun ZJ, Li W, Yang Z. Inflammatory pseudotumor of the colon causing intussusception: A case report and literature review. World J Gastroenterol 2015; 21:704-710. [PMID: 25593502 PMCID: PMC4292308 DOI: 10.3748/wjg.v21.i2.704] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/18/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of unknown etiology that can mimic malignancy on clinic-radiological and pathological examination. We describe a rare case of ileocecal intussusception from clinically suspected malignancy of the right colon where the patient underwent right hemicolectomy. Histopathology of the resected specimen confirmed IPT of the colon. This patient was observed to have abnormally elevated total leukocyte count and platelets before and after surgery. In an adult with intussusception associated with an abdominal mass, the possibility of IPT of the colon should be considered. Considering the abnormally high total leukocyte and platelet counts and colonic IPT, it is necessary to prevent postoperative adverse effects due to these changes. Although IPT of the colon is usually a benign process, controversy regarding its management still exists. We consider hemicolectomy as a safe treatment approach for colonic IPT and review the existing literature.
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17
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Vardas K, Manganas D, Papadimitriou G, Kalatzis V, Kyriakopoulos G, Chantziara M, Exarhos D, Drakopoulos S. Splenic inflammatory pseudotumor-like follicular dendritic cell tumor. Case Rep Oncol 2014; 7:410-6. [PMID: 25076893 PMCID: PMC4107821 DOI: 10.1159/000365000] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Inflammatory pseudotumor of the spleen with expression of follicular dendritic cell markers is an extremely rare lesion with only a few cases reported previously. The present study reports on an inflammatory pseudotumor of the spleen 10 × 8 × 7 cm in size that was incidentally found in a 61-year-old man and increased gradually in size during a period of 3 months. Abdominal ultrasonography revealed a well-circumscribed splenic mass, and abdominal computed tomography confirmed the presence of a well-circumscribed isodense lesion in the splenic hilum with inhomogenous enhancement in the early-phase images and no enhancement on delayed-phase contrast-enhanced images. Magnetic resonance imaging of the abdomen showed a well-defined isodense tumor on T1-weighted images with mildly increased signal intensity on T2-weighted images, and this is only the second study that provides MRI findings of this entity. The patient underwent an uncomplicated open splenectomy for definitive histologic diagnosis. Under microscopic examination, the lesion was an admixture of lymphocytes, plasma cells and spindle cells. In situ hybridization analysis for Epstein-Barr virus (EBV) revealed that most of the spindle cells were positive for EBV, and immunochemistry showed the expression of the follicular dendritic cell markers CD21, CD35 and CD23 within the tumor. The diagnosis of inflammatory pseudotumor-like follicular dendritic cell tumor was established.
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Affiliation(s)
| | | | | | | | | | - Maria Chantziara
- Department of Pathology, Evangelismos General Hospital, Athens, Greece
| | - Dimitrios Exarhos
- Department of Radiology, Evangelismos General Hospital, Athens, Greece
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18
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Matsuo Y, Sato M, Shibata T, Morimoto M, Tsuboi K, Shamoto T, Hirokawa T, Sato T, Takahashi H, Takeyama H. Inflammatory pseudotumor of the liver diagnosed as metastatic liver tumor in a patient with a gastrointestinal stromal tumor of the rectum: report of a case. World J Surg Oncol 2014; 12:140. [PMID: 24886578 PMCID: PMC4016664 DOI: 10.1186/1477-7819-12-140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/27/2014] [Indexed: 01/14/2023] Open
Abstract
Background Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion. A case of IPT of the liver found in association with a malignant gastrointestinal stromal tumor (GIST) is reported. Case report A 74-year-old man was admitted to our hospital for a liver tumor. He previously underwent rectal amputation for a malignant GIST. Computed tomography (CT) revealed a low-density area in the liver and dynamic contrast-enhanced MRI (EOB-MRI) showed that the tumor was completely washed out in the delayed phase. 18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) showed strong uptake in the liver. A diagnosis of liver metastasis was made and partial hepatectomy was performed. Microscopic examination showed that the tumor was an IPT. Conclusion Differential diagnosis between IPT and malignant neoplasms is difficult. Moreover, FDG-PET revealed strong uptake in the tumor. To our knowledge, this is the first patient reported to have an IPT in association with a rectal GIST. This patient is discussed along with a review of the literature.
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Affiliation(s)
- Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan.
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19
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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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20
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Loughlin P, Brady A, Devlin E, McManus DT, Spence RAJ. Epstein-Barr virus positive inflammatory pseudo-tumour of the spleen: A case report and literature review. Int J Surg Case Rep 2014; 5:186-8. [PMID: 24632301 PMCID: PMC3980515 DOI: 10.1016/j.ijscr.2013.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 11/12/2013] [Accepted: 12/05/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Epstein–Barr virus positive inflammatory pseudo-tumour (IPT) of the spleen is an uncommon, frequently asymptomatic entity, which is typically picked up as an incidental finding on imaging. PRESENTATION OF CASE We present a case of EBV positive IPT of the spleen which presented as an incidental finding on CT in a patient with a history of malignancy. Splenectomy was performed. DISCUSSION IPTs are benign spindle cell lesions of varying aetiology, which can arise in a variety of tissues, including the spleen. In situ hybridisation showed strong staining for Epstein–Barr virus RNA in our case, in common with many similar lesions described in the literature. The differential diagnosis of such spindle cell tumours is discussed. CONCLUSION Radiologically, EBV positive spindle cell tumours are indistinguishable from malignant lesions such as lymphoma and diagnosis is made on histology, usually at splenectomy.
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Affiliation(s)
- P Loughlin
- Department of Surgery, Belfast City Hospital, United Kingdom.
| | - A Brady
- Department of Pathology, Belfast City Hospital, United Kingdom
| | - E Devlin
- Department of Surgery, Belfast City Hospital, United Kingdom
| | - D T McManus
- Department of Pathology, Belfast City Hospital, United Kingdom
| | - R A J Spence
- Department of Surgery, Belfast City Hospital, United Kingdom
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21
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Palomeque Jiménez A, Reyes Moreno M, Calzado Baeza S, Ranea Jimena SA, Robayo Soto PS. [Detection of Epstein-Barr virus in an inflammatory myofibroblastic tumor of the spleen (inflammatory pseudotumor)]. Cir Esp 2014; 93:e41-3. [PMID: 24462269 DOI: 10.1016/j.ciresp.2013.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/18/2013] [Accepted: 03/25/2013] [Indexed: 11/27/2022]
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22
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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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23
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Ma ZH, Tian XF, Ma J, Zhao YF. Inflammatory pseudotumor of the spleen: A case report and review of published cases. Oncol Lett 2013; 5:1955-1957. [PMID: 23833674 PMCID: PMC3701001 DOI: 10.3892/ol.2013.1286] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/12/2013] [Indexed: 12/28/2022] Open
Abstract
Inflammatory pseudotumor of the spleen (IPTS) is an extremely rare condition. To the best of our knowledge, only ∼113 cases have been reported in the literature since the first 2 cases were reported in 1984. The present study reports the case of an IPTS in a 72-year-old male patient. The splenic tumor was identified incidentally 1 year prior to the patient being admitted to the Second Affiliated Hospital of Dalian Medical University (Dailan, China). There were no specific clinical symptoms. The initial diagnosis was of splenic lymphoma based on the pre-operative radiological findings. However, the patient underwent a splenectomy and the final pathological diagnosis of IPTS was declared. The present study also highlighted the difficulty of forming accurate pre-operative diagnoses, even when using modern imaging techniques. A partial resection of the spleen or splenectomy was considered to be the required treatment to form a definitive diagnosis and exclude malignancy. The prognosis of IPTS is generally considered to be favorable following splenectomy. The clinical and pathological features of previously reported cases are also briefly reviewed in the present study to aid in improving the accuracy of the diagnosis of this rare disease.
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Affiliation(s)
- Zhen-Hai Ma
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
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Sarrami AH, Baradaran-Mahdavi MM, Meidani M. Precise recognition of liver inflammatory pseudotumor may prevent an unnecessary surgery. Int J Prev Med 2012; 3:432-4. [PMID: 22783471 PMCID: PMC3389442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 03/30/2012] [Indexed: 11/02/2022] Open
Abstract
Liver inflammatory pseudotumor (IPT) is considered a benign inflammatory lesion mostly presented as a solitary solid mass in the right hepatic lobe. It may clinically and radiologically mimic a malignant liver tumor or an abscess. Accordingly, diagnoses of most of the reported cases have been established after surgical resection. In this report, we describe a 52-year-old woman with a 1-year history of fever of unknown origin. In the following investigation, abdominal computed tomography (CT) scan showed infiltrative lesion in the right hepatic lobe. The patient underwent a CT-guided needle biopsy of the hepatic lesion. Histopathologic study of biopsy specimen revealed the features of IPT. The patient was discharged and followedup for 6 months. After 6 months she had no complaint of fever and control liver ultrasonography disclosed no lesion. As liver IPT has favorable response to conservative therapy and may also resolve spontaneously, precise recognition of this condition with the help of fine-needle biopsy may help to avoid unnecessary surgery.
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Affiliation(s)
- Amir Hossein Sarrami
- Medical Students’ Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohsen Meidani
- Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Mr. Mohsen Meidani, Alzahra Hospital, Isfahan University of Medical Sciences, Soffeh Street, Isfahan 81744, Iran. E-mail:
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