Diagnosis of hepatic inflammatory pseudotumor by fine-needle biopsy

Lin, Min; Cao, Liang; Wang, Jianwei; Zhou, Jianhua

doi:10.1016/j.jimed.2022.04.002

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…Moreover, since neither imaging modalities nor biochemical tests provide conclusive evidence of IPT [15], it is not easy to distinguish IPT from malignant liver tumors including hepatocellular carcinoma, Diagnostics 2023, 13, 2857 2 of 13 cholangiocellular carcinoma, cholangiolocellular carcinoma and metastatic liver cancer. Indeed, liver tumor markers such as AFP, PIVKA II, and CEA were almost within normal limits in the reported references [16,17]; however, liver function tests such as ALT and AST showed multifield increases due to inflammation in the reported references [17].…”

Section: Introductionmentioning

confidence: 85%

Hepatic Inflammatory Pseudotumor—Focusing on Its Heterogeneity

Kim,

Koma

et al. 2023

Diagnostics

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Hepatic inflammatory pseudotumors (IPTs) are defined as benign, non-malignant, non-metastasizing tumors characterized by the presence of myofibroblastic spindle cells, hetorogenous populations of inflammatory cells, particularly plasma cells, lymphocytes and macrophages, as well as locations of fibrosis and necrosis without cellular anaplasia or atypical mitoses. Despite subsequent reports in the references, hepatic IPT remains difficult to diagnose; while posing major issues specifically for its differential diagnosis compared with that of other various benign diseases and malignant hepatic tumors. Histopathological findings are always a requisite for confirming the diagnosis, particularly given that the pathogenesis of IPT remains ambiguous to date. Hepatic IPT is a heterogeneous entity in terms of its clinical features, pathological findings, and pathogenesis. Once the diagnosis is confirmed, however, needless surgery such as wedge resection and lobectomy should be avoided. Here, we discuss the heterogeneity of hepatic IPT, its clinical features, pathological findings, and pathogenesis, and describe its differential diagnosis.

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Section: Introductionmentioning

confidence: 85%

Hepatic Inflammatory Pseudotumor—Focusing on Its Heterogeneity

Kim,

Koma

et al. 2023

Diagnostics

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Klebsiella liver phlegmon mimicking a solid liver tumour

Necas,

Mitchell

2024

Australas J Ultrason Med

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IntroductionThis case examines the sonographic and clinical challenge of diagnosing a Klebsiella pnumoniae pyogenic liver abscess with systemic metastatic infection.Case DescriptionThe patient in this case study is an 81‐year‐old man who presented with intermittent rigors. Following radiological and clinical assessments, a Klebsiella pnumoniae pyogenic liver abscess, with evidence of systemic metastatic infection, was diagnosed. Sonographic features of the liver abscess were atypical for a cystic lesion and instead appeared as a solid mass, raising the possibility of malignancy. Treatment of intravenous ceftriaxone infusions resulted in full resolution of the liver lesion.DiscussionThe discussion criticises the terminology when describing hepatic lesions, which result from a Klebsiella pnumoniae infection. The term hepatic phlegmon is appropriate when a liver lesion caused by bacterial infection demonstrates a solid appearance on radiologic imaging. The term hepatic abscess is appropriate in cases where liver lesions caused by bacterial infection demonstrate a fluid filled core on radiologic imaging. Differentiation of these terms is important when treating the underlying lesion as a phlegmon, in contrast to an abscess, cannot be drained because it contains no pus. The variable sonographic appearances of Klebsiella pnumoniae pyogenic abscesses were also examined. Despite reported sonographic appearances in the literature, none are sufficient to distinguish a pyogenic liver abscess from malignancy without further investigation.ConclusionUltrasound operators should be aware of the variable sonographic appearances of a Klebsiella pnumoniae liver abscess and how these features, combined with non‐homogenous terminology, can obfuscate the correct diagnosis.

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