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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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2
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Shen L, Yang Z, Ding R, Wei W, Xu Y. Hepatic inflammatory myofibroblastic tumor: One case report. Front Surg 2022; 9:902753. [PMID: 35990088 PMCID: PMC9386116 DOI: 10.3389/fsurg.2022.902753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Hepatic inflammatory myofibroblastic tumor (HIMT) is a junctional neoplastic lesion of mesenchymal tissue origin that can sometimes become locally invasive and even metastasize or recur. Therefore, the diagnosis and treatment of HIMT is particularly important. However, hepatic inflammatory myofibroblastic tumor lacks a specific clinical presentation and typical imaging manifestations, thus posing a difficulty for us to diagnose and treat this disease. Case Presentation We report here a very rare surgical case of hepatic inflammatory myofibroblastic tumor (HIMT) in a 41-year-old female who was admitted to the hospital for more than half a month for a liver-occupying lesion with fever found on physical examination.After discussion with the hepatobiliary and pancreatic surgery team, we decided to perform surgical treatment. The final postoperative pathology confirmed hepatitis myofibroblastoma. Conclusion Our review of the domestic and international literature revealed no significant progress in the diagnosis and treatment of this disease, so we report here a case of surgical treatment. One of our aims in this case report is to highlight the efficacy of surgical treatment in HIMT. HIMT is extremely rare and difficult to diagnose. Due to their intermediate biological behavior, surgical resection should be performed whenever feasible and patients should be followed-up in order to detect recurrence and metastasis as early as possible.
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Kanagalingam G, Dulymamode KN, Jafroodifar A, Huda SA, May A, Masood U, John S. Enlarging Liver Mass: Inflammatory Pseudotumor in a Patient With Polymyalgia Rheumatica. J Investig Med High Impact Case Rep 2022; 10:23247096211070387. [PMID: 35038943 PMCID: PMC8961211 DOI: 10.1177/23247096211070387] [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] [Indexed: 11/28/2022] Open
Abstract
Inflammatory pseudotumors of the liver are rare, non-neoplastic liver tumors. Due to the
nonspecific clinical presentation, imaging features, and histopathological findings, they
can mimic malignant tumors requiring invasive diagnostics. We present a case of a
61-year-old female patient with a history of type 2 diabetes mellitus, hypothyroidism,
hyperlipidemia, and polymyalgia rheumatica who had initially presented with abdominal pain
for 3 weeks. Further workup showed normal liver chemistries and tumor markers: AFP and CA
19-9. Magnetic resonance imaging (MRI) of the abdomen showed a segment 6 lesion measuring
4.1 × 4.0 × 3.7 cm. A liver biopsy then confirmed the diagnosis of an inflammatory
pseudotumor of the liver with negative IgG4. On follow-up imaging, a rapid growth of this
liver lesion was noted. Laparoscopy was done but did not show any distinct liver lesion.
Follow-up imaging confirmed a decrease in the size of the mass. Interestingly, the patient
had been on a higher dose of steroids for her polymyalgia rheumatic leading up to the
follow-up imaging. This is the first case of an inflammatory pseudotumor of the liver in a
patient with polymyalgia rheumatica. With this case, we would like to increase the
awareness for inflammatory pseudotumors of the liver as a differential diagnosis of liver
lesions in patients with underlying autoimmune disorders.
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Affiliation(s)
| | | | - Abtin Jafroodifar
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Syed A Huda
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Adriana May
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Umair Masood
- Department of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Savio John
- Department of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA
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Calistri L, Maraghelli D, Nardi C, Vidali S, Rastrelli V, Crocetti L, Grazioli L, Colagrande S. Magnetic resonance imaging of inflammatory pseudotumor of the liver: a 2021 systematic literature update and series presentation. Abdom Radiol (NY) 2022; 47:2795-2810. [PMID: 35648207 PMCID: PMC9300573 DOI: 10.1007/s00261-022-03555-9] [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: 03/07/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Inflammatory pseudotumors of the liver (IPTL) are not exceptional benign lesions with various etiologies, histology, and imaging appearances. The incomplete knowledge of this pathology and the wide polymorphism sometimes resembling malignancy often induce long and expensive diagnostic flow, biopsy and occasionally unnecessary surgery. We propose a systematic revision of MRI literature data (2000-2021) with some narrative inserts and 10 new complete MRI cases, with the aim of organizing the data about IPTL and identifying some typical features able to improve its diagnosis from imaging. METHODS We performed a systematic revision of literature from 2000 to 2021 to obtain MRI features, epidemiological, and clinical data of IPTL. The basic online search algorithm on the PubMed database was "(pseudotumor) AND (liver) AND (imaging)." Quality assessment was performed using both scales by Moola for case report studies and by Munn for cross-sectional studies reporting prevalence data. A case-based retrospective study by collecting patients diagnosed with IPTL from three different university hospitals from 2015 to 2021 was done as well. Only cases with MR examinations complete with T1/T2/contrast-enhanced T1/Diffusion-Weighted (W) images and pathology-proven IPTL were selected. RESULTS After screening/selection 38 articles were included for a total of 114 patients. In our experience we selected 10 cases for a total of 16 IPTLs; 8 out of 10 patients underwent at least 1 MRI follow-up. Some reproducible and rather typical imaging findings for IPTL were found. The targetoid aspect of IPTL is very frequent in our experience (75% on T1W, 44% on T2W, 81% on contrast-enhanced T1W (at least one phase), 100% on Diffusion-W images) but is also recurrent in the literature (6% on T1W, 31% on T2W, 51% on CE-T1W (at least one phase), 18% on Diffusion-W images, and 67% on hepatobiliary phase). In our experience, Apparent Diffusion Coefficient map values were always equal to or higher than those of the surrounding parenchyma, and at MRI follow-up, nodule/s disappeared at first/second control, in six patients, while in the remaining 2, lesions persisted with tendency to dehydration. CONCLUSION A targetoid-like aspect of a focal liver lesion must raise diagnostic suspicion, especially if IgG4-positive plasma is detected. MRI follow-up mainly shows the disappearance of the lesion or its reduction with dehydration.
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Affiliation(s)
- Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Sofia Vidali
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Vieri Rastrelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Laura Crocetti
- Clinical and Translational Science Research Department - Division of Interventional Radiology, Cisanello University Hospital, Bldg 30, Via Paradisa 2, 56124 Pisa, Italy
| | - Luigi Grazioli
- Department of Radiology, University of Brescia “Spedali Civili”, P. le Spedali Civili 1, Brescia, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
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Li J, Tao HS, Chen D, Huang ZY, Zhang EL. Hepatic inflammatory pseudotumor-like follicular dendritic cell tumor with hepatic lymphoma history: A case report and literature review. Medicine (Baltimore) 2021; 100:e27392. [PMID: 34596165 PMCID: PMC8483863 DOI: 10.1097/md.0000000000027392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hepatic inflammatory pseudotumor (IPT)-like follicular dendritic cell (FDC) sarcoma is a very rare disease. Till now, only 19 cases were reported in the English literature. However, the coexistence of IPT-like sarcoma and non-Hodgkin lymphoma (NHL) in the same patient has never been reported. In this report, we presented a case of hepatic IPT-like FDC with hepatic NHL history of which both were successfully resected. PATIENT CONCERNS We reported a case of a 47-year-old male patient who presented with right upper abdominal discomfort. Nineteen years ago, he underwent liver resection of segment VII for hepatic NHL (B-cell lymphoma). He had a history of chronic hepatitis B virus infection. Serum alpha fetoprotein level was normal. However, imaging studies revealed a well-circumscribed, solid mass in the right hepatic lobe, he came back to the clinic because he was worried about a recurrence of the B-cell lymphoma. DIAGNOSES Based on the patient's past medical history and magnetic resonance imaging results, and he was diagnosed as hepatocellular carcinoma or hepatic NHL preoperatively. INTERVENTIONS Right hemi-hepatectomy was performed on this patient. OUTCOMES Histological report showed features of a mixture of chronic inflammatory cells and variable amounts of spindle cells. Also, immuno-histo-chemical studies demonstrated that all the tumor cells showed strong nuclear in situ labeling for EBV-encoded small RNAs and strongly positive stainings with CD21 and CD35. The patient tolerated the surgery well, recovered smoothly and he was discharged on postoperative day 7 (day 7). The patient is still disease free after a follow-up of over 50 months. CONCLUSIONS To our knowledge, this is the first report demonstrating hepatic IPT-like FDC sarcoma in a patient with primary hepatic NHL history. In regards to treatment, complete surgical resection should be performed and would acquire excellent long-term outcomes.
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Affiliation(s)
- Jiang Li
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, College of Medicine, Shihezi University, Shihezi, Xinjiang, PR China
| | - Hai-Su Tao
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Dong Chen
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Zhi-Yong Huang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Er-Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Maruno M, Imai K, Nakao Y, Kitano Y, Kaida T, Mima K, Hayashi H, Yamashita YI, Mikami Y, Baba H. Multiple hepatic inflammatory pseudotumors with elevated alpha-fetoprotein and alpha-fetoprotein lectin 3 fraction with various PET accumulations: a case report. Surg Case Rep 2021; 7:107. [PMID: 33913027 PMCID: PMC8081814 DOI: 10.1186/s40792-021-01188-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/18/2021] [Indexed: 01/08/2023] Open
Abstract
Background Hepatic inflammatory pseudotumor (IPT) is a rare, benign, tumor-like lesion. Because there are no characteristic laboratory markers or radiological features, hepatic IPT is often misdiagnosed as a malignant neoplasm such as hepatocellular carcinoma (HCC). Case presentation A 68-year-old man with liver dysfunction due to chronic hepatitis C virus infection and alcoholic liver disease presented with hepatic tumors in segments III and VIII. The levels of serum alpha-fetoprotein (AFP) and its Lens culinaris agglutinin-reactive fraction, AFP lectin 3 (AFP-L3), were elevated to 822.8 ng/ml and 75.2%, respectively. The tumor showed contrast enhancement on contrast-enhanced computed tomography and various accumulation on positron emission tomography. Based on these biological and imaging features, HCC was suspected, and we performed laparoscopic partial hepatectomy for these two tumors. Pathological diagnosis revealed that both tumors were hepatic IPTs with no malignant characteristics. After hepatectomy, the serum AFP and AFP-L3 levels decreased to the normal range. Conclusion We report a very rare case of hepatic IPT with elevated serum AFP and AFP-L3, mimicking HCC. Clinicians should include this rare neoplasm in the differential diagnoses of hepatic tumors even when the serum markers for HCC are elevated.
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Affiliation(s)
- Masataka Maruno
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Yosuke Nakao
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuki Kitano
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takayoshi Kaida
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kosuke Mima
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Ichikawa S, Motosugi U, Suzuki T, Shimizu T, Onishi H. Imaging features of hepatic inflammatory pseudotumor: distinction from colorectal liver metastasis using gadoxetate disodium-enhanced magnetic resonance imaging. Abdom Radiol (NY) 2020; 45:2400-2408. [PMID: 32468212 DOI: 10.1007/s00261-020-02575-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To identify gadoxetate disodium-enhanced MRI features distinguishing hepatic IPT from CLM. METHODS From February 2008 to December 2019, 162 lesions (IPT, n = 31 and CLM, n = 131) from 94 patients (mean age 65.1 ± 12.2 years; 65 men and 29 women) were retrospectively assessed for the presence or absence of obscure boundary, rim enhancement on arterial phase (AP), persistent rim enhancement during AP to transitional phase (TP), blood vessel penetration, peritumoral parenchymal enhancement on AP, peritumoral parenchymal hypointensity on hepatobiliary phase (HBP), peritumoral parenchymal hyperintensity on T2-weighted imaging (T2WI), biliary dilatation, central hypointensity with a relatively hyperintense periphery on HBP, peripheral hyperintensity on diffusion-weighted imaging (DWI) and T2WI, and lesion to liver signal intensity ratio (SIRlesion/liver) on HBP and DWI. Relevant features for differentiating between ITP and CLM were identified by univariate and multivariate analyses. RESULTS Univariate analysis revealed significantly higher frequencies of the following features in IPT than CLM: younger age, obscure boundary, blood vessel penetration, central hypointensity with a relatively hyperintense periphery on HBP, higher SIRlesion/liver on HBP, and lower SIRlesion/liver on DWI (P < 0.001‒0.035). Rim enhancement on AP and persistent rim enhancement during AP to TP were significantly more common in CLM than in IPT (P ≤ 0.001). Multivariate analysis revealed that a central hypointensity with a relatively peripheral hyperintensity on HBP, higher SIRlesion/liver on HBP, and lower SIRlesion/liver on DWI were predictive of IPT (P = 0.003‒0.039). CONCLUSION Central hypointensity with a relatively peripheral hyperintensity on HBP and SIRlesion/liver on HBP and DWI may be reliable gadoxetate disodium-enhanced MRI features for distinguishing IPT from CLM.
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Affiliation(s)
- Shintaro Ichikawa
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
- Department of Diagnostic Radiology, Kofu Kyoritsu Hospital, Kofu, Japan.
| | - Tatsuya Suzuki
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Tatsuya Shimizu
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, 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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9
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Hepatic Inflammatory Pseudotumor: An Important Differential Diagnosis in Patients With a History of Previous Biliary Procedures. ACG Case Rep J 2019; 6:e00015. [PMID: 31598534 PMCID: PMC6657982 DOI: 10.14309/crj.0000000000000015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/16/2018] [Indexed: 12/20/2022] Open
Abstract
Hepatic inflammatory pseudotumors (IPTs) are rare lesions that mimic malignancy clinically, radiologically, and pathologically. The pathophysiology is unknown, and no criteria exist for diagnosis. This series includes 3 cases: 1 patient had recent biliary drainage with bile duct stent placement, and the other 2 patients had hepatic abscess formation before IPT development, which further supports that hepatic IPTs develop in patients with underlying triggers of liver inflammation and injury, including infections and/or bile leakage into the parenchyma. All 3 patients were successfully treated with antibiotics, sparing them surgical intervention. Follow-up showed complete resolution, and none developed recurrences or malignancies.
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10
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Pantiora EV, Sakellaridis EP, Kontis EA, Fragulidis GP. Inflammatory Pseudotumor of the Liver Presented in a Patient with Cholelithiasis. Cureus 2018; 10:e3231. [PMID: 30410837 PMCID: PMC6207491 DOI: 10.7759/cureus.3231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An inflammatory pseudotumor of the liver is a rare tumor-like lesion consisting of an inflammatory infiltrate that often can mimic a malignant liver neoplasm. The cause of an inflammatory pseudotumor of the liver is unknown, but it has been reported to be associated with different comorbid conditions most likely inflammatory or infectious in origin. We present an 83-year-old female who presented with a symptomatic gallstones disease and an incidental finding of inflammatory pseudotumor mimicking intrahepatic cholangiocarcinoma in preoperative liver imaging. Differentiating a pseudotumor from hepatic space-occupying neoplasms is crucial since it is one of the most important tumor-mimicking lesions. The imaging findings of this rare tumor can pose diagnostic difficulties because of the amount of fibrosis and cellular infiltration. If malignancy has been excluded, patients can be treated conservatively with steroids and non-steroidal anti-inflammatory drugs. However, complete surgical resection has been the modality of treatment for most of the cases with an indeterminate diagnosis.
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Affiliation(s)
- Eirini V Pantiora
- 2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Epameinondas P Sakellaridis
- 2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Elissaios A Kontis
- 2nd Department of Surgery, Aretaieio Hospital, The National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Georgios P Fragulidis
- 2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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11
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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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12
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Wu CH, Chiu NC, Yeh YC, Kuo Y, Yu SS, Weng CY, Liu CA, Chou YH, Chiou YY. Uncommon liver tumors: Case report and literature review. Medicine (Baltimore) 2016; 95:e4952. [PMID: 27684838 PMCID: PMC5265931 DOI: 10.1097/md.0000000000004952] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Beside hepatocellular carcinoma, metastasis, and cholangiocarcinoma, the imaging findings of other relatively uncommon hepatic lesions are less discussed in the literature. Imaging diagnosis of these lesions is a daily challenge. In this article, we review the imaging characteristics of these neoplasms. METHODS From January 2003 to December 2014, 4746 patients underwent liver biopsy or hepatic surgical resection in our hospital. We reviewed the pathological database retrospectively. Imaging of these lesions was reviewed. RESULTS Imaging findings of uncommon hepatic lesions vary. We discuss the typical imaging characteristics with literature review. Clinical and pathological correlations are also described. Primary hepatic lymphoma consists only of 1% of the extranodal non-Hodgkin lymphoma, and is defined as the one involving only the liver and perihepatic lymph nodes within 6 months after diagnosis. Combined hepatocellular and cholangiocarcinoma (cHCC-CC) shares some overlapping imaging characteristics with both HCC and cholangiocarcinoma because of being an admixture of them. Angiosarcoma is the most common hepatic mesenchymal tumor and is hypervascular in nature. Inflammatory pseudotumor is often heterogeneous on ultrasonography and with enhanced septations and rims in the portovenous phase after contrast medium. Angiomyolipoma (AML) typically presents with macroscopic fat components with low signal on fat-saturated magnetic resonance imaging (MRI) and presence of drainage vessels. Intraductal papillary neoplasm of the bile duct (IPNB) is thought of as a counterpart to the pancreatic intraductal papillary mucinous neoplasm. Most of the IPNBs secrete mucin and cause disproportional dilatation of the bile ducts. Mucinous cystic neoplasm (MCN) contains proteinaceous and colloidal components without ductal communication and characterizes with hyperintensity on T1-weighted imaging. Other extremely rare lesions, including epithelioid hemangioendothelioma and inflammatory pseudotumor-like follicular dendritic cell sarcoma, are also discussed. Hepatoblastoma and mesenchymal hamartoma, mostly in children, are also briefly reviewed as well. CONCLUSION It is important for radiologists to be familiar with the typical imaging features of the uncommon hepatic neoplasms. If imaging findings are not typical or diagnostic, further biopsy is required.
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Affiliation(s)
- Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Nai-Chi Chiu
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Yi-Chen Yeh
- School of Medicine, National Yang-Ming University
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu Kuo
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Sz-Shian Yu
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Ching-Yao Weng
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Yi-You Chiou
- Department of Radiology, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University
- Correspondence: Yi-You Chiou, Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Beitou District, Taipei, 11217, Taiwan (e-mail: )
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Shibata M, Matsubayashi H, Aramaki T, Uesaka K, Tsutsumi N, Sasaki K, Ono H. A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment. BMC Gastroenterol 2016; 16:89. [PMID: 27484098 PMCID: PMC4970241 DOI: 10.1186/s12876-016-0504-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 07/26/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hepatic inflammatory pseudotumor (IPT) is a rare disease which often mimics a malignant tumor and is therefore often misdiagnosed and surgically resected. Recently, a concept of IgG4-related diseases (IgG4-RD) has been proposed that is becoming widely recognized and includes IgG4-related hepatic IPT. Corticosteroids are widely accepted as the standard treatment. CASE PRESENTATION A 72-year-old Japanese man, who had been followed for ten years after surgery and chemotherapy for treatment of hilar and lower bile duct cancers, developed intermittent fever and abdominal pain and visited this hospital. Blood examinations revealed an inflammatory reaction, worsened glucose intolerance, and an increased level of serum IgG4 (137 mg/dL). Computed tomography (CT) revealed a 5 cm-sized mass in hepatic segment 7. Because of his cancer history, not only was a benign mass suspected, but there was also the possibility of a recurrent biliary malignancy. Liver biopsy was performed and the histology met the criteria for IgG4-related IPT. Corticosteroid therapy was initiated and his symptoms quickly resolved. However, two months later, a repeat CT demonstrated that the hepatic mass had been replaced by an abscess. The abscess was initially refractory, despite tapering corticosteroid treatment, controlling diabetes by intensive insulin therapy, administration of antibiotics, and percutaneous abscess drainage. Finally, after six months, the condition resolved. CONCLUSION The diagnosis of hepatic IPT is sometimes difficult. To differentiate it from a malignant tumor, histological examination is necessary. Although corticosteroids are recognized as the standard therapy, unexpected and critical complications can develop in cases of IgG4-related hepatic IPT.
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Affiliation(s)
- Masayuki Shibata
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Hiroyuki Matsubayashi
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan.
| | - Tsuyoshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Naoyuki Tsutsumi
- Division of Infectious Diseases, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
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Lv A, Liu W, Qian HG, Leng JH, Hao CY. Reactive lymphoid hyperplasia of the liver mimicking hepatocellular carcinoma: incidental finding of two cases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:5863-5869. [PMID: 26191310 PMCID: PMC4503181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 04/26/2015] [Indexed: 06/04/2023]
Abstract
Reactive lymphoid hyperplasia is a rare disease that forms a mass-like lesion and is characterized by the proliferation of non-neoplastic, polyclonal lymphocytes forming follicles. We recently encountered 2 cases of reactive lymphoid hyperplasia of liver, both of which were asymptomatic and mimicked hepatocellular carcinoma by various imaging modalities. Based on the clinical impression of hepatocellular carcinoma, surgical resections were performed. Microscopic findings revealed that both lesions consisted of an aggregation of lymphocytes consisting of predominantly B-cells, with multiple lymphoid follicles positive for CD10 and negative for bcl-2, consistent with the diagnosis of reactive lymphoid hyperplasia. Polyclonality of both lesions was further confirmed by B cell receptor gene rearrangement study. The incidence of reactive lymphoid hyperplasia in the liver is exceedingly rare, and it is difficult to differentiate such lesions from hepatic malignancies based upon clinical grounds. The clinicopathological findings and literature review of this report may be helpful to improve the clinical decision-making.
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Affiliation(s)
- Ang Lv
- Department of Hepato-Pancreato-Biliary Surgery, Peking University School of Oncology, Beijing Cancer Hospital & Institute#52 Fucheng Road, Haidian District, Beijing 100142, People’s Republic of China
| | - Wendy Liu
- Department of Pathology, University Hospitals Case Medical Center11100 Euclid Avenue, Cleveland, OH44106, USA
| | - Hong-Gang Qian
- Department of Hepato-Pancreato-Biliary Surgery, Peking University School of Oncology, Beijing Cancer Hospital & Institute#52 Fucheng Road, Haidian District, Beijing 100142, People’s Republic of China
| | - Jia-Hua Leng
- Department of Hepato-Pancreato-Biliary Surgery, Peking University School of Oncology, Beijing Cancer Hospital & Institute#52 Fucheng Road, Haidian District, Beijing 100142, People’s Republic of China
| | - Chun-Yi Hao
- Department of Hepato-Pancreato-Biliary Surgery, Peking University School of Oncology, Beijing Cancer Hospital & Institute#52 Fucheng Road, Haidian District, Beijing 100142, People’s Republic of China
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