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]
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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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