Inflammatory pseudotumor of the liver: Case report and review of the literature

Sakai, Masato; Ikeda, Hitoshi; Suzuki, Norio; Takahashi, Atsushi; Kuroiwa, Minoru; Hirato, Junko; Hatakeyama, Shinitsu; Tsuchida, Yoshiaki

doi:10.1053/jpsu.2001.22316

Cited by 50 publications

(43 citation statements)

References 19 publications

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“…IPTs generally are benign mixed inflammatory masses, described in many different organs including the lung and liver. [1][2][3][4][5][6] Because of the heterogeneity of the cellular infiltrate, these lesions also have been reported as inflammatory myofibroblastic tumors, plasmacell granulomas, and fibroxanthomas. 2 Although the etiology is largely unknown, IPTs commonly occur after infection, trauma, or other inflammatory reaction.…”

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“…Patients can be asymptomatic or present with constitutional symptoms and abnormal laboratory values including leukocytosis, hypergammaglobulinemia, and an elevated erythrocyte sedimentation rate. 3 The lesions may grow to alarming sizes causing significant pain. IPTs typically are identified, often incidentally, as mass lesions through routine radiographic imaging.…”

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Inflammatory pseudotumor: A diagnostic dilemma in cytopathology

Hosler

Steinberg

Sheth

et al. 2004

Diagnostic Cytopathology

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Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of unknown etiology that can mimic malignancy on clinicoradiological and pathological examination. A review of the cytopathology archives at The Johns Hopkins Hospital identified 12 cases from eight patients with histologically proven IPT (lung, seven patients; liver, five patients). There were six men and two women with an age range of 28-84 yr (mean age, 59 yr). Presenting complaints of IPT of the lung included shortness of breath and hemoptysis, and in cases of IPT of the liver complaints included abdominal pain and elevated liver function tests (LFTs). All cases were found to have mass lesions suspicious for a neoplasm on radiographic examination. Cytological specimens consisted of fine-needle aspiration (FNA; seven specimens) and bronchial brush/wash (five specimens). Diagnostic accuracy of cytology for IPT was low (5/12, 42%). IPT showed hypercellular smears (on FNA) with an admixture of various cell types including inflammatory cells with predominance of plasma cells, fibroblastic proliferation, granulation tissue formation, and atypical-appearing histiocytes with enlarged nuclei and intranuclear inclusions. Fibroblastic proliferation with mitoses may mimic mesenchymal neoplasms. Cytomorphology is nonspecific and IPT usually is a diagnosis of exclusion.

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Inflammatory pseudotumor: A diagnostic dilemma in cytopathology

Hosler

Steinberg

Sheth

et al. 2004

Diagnostic Cytopathology

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“…There have also been reports of rare associations of FNH with other types of vascular anomalies [28,34], which lend support to the hypothesis that multiple FNH nodules occur within a syndromal context [7] related to irregular arterial support in the liver with areas of localized hypoperfusion. These associated anomalies include congenital absence of the portal vein [35,36], inflammatory pseudotumors of the liver [37], hepatic-vein thrombosis [38], and intrahepatic arterovenous shunting [39]. FNH has occasionally been found in association with extrahepatic pathology such as cerebrovascular anomalies [40], sickle-cell anemia [41], cystic dysplasia of the kidney [35], KlippeleTrenaunay syndrome [42], cerebral meningiomas and astrocytomas [28], and hereditary hemorrhagic telangiectasia [43].…”

Section: Associated Conditionsmentioning

confidence: 99%

Diagnosis and management of hepatic focal nodular hyperplasia

Venturi

Piscaglia

Vidili

et al. 2007

Journal of Ultrasound

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Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver, after hemangioma. It is generally found incidentally and is most common in reproductive-aged women, but it also affects males and can be diagnosed at any age. Patients are rarely symptomatic, but FNH sometimes causes epigastric or right upper quadrant pain. The main clinical task is to differentiate it from other hypervascular hepatic lesions such as hepatic adenoma, hepatocellular carcinoma, or hypervascular metastases, but invasive diagnostic procedures can generally be avoided with the appropriate use of imaging techniques. Magnetic resonance (MR) imaging is more sensitive and specific than conventional ultrasonography (US) or computed tomography (CT), but Doppler US and contrast-enhanced US (CEUS) can greatly improve the accuracy in the diagnosis of FNH. Once a correct diagnosis has been made, in most cases there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients.Sommario L'iperplasia nodosa focale (FNH) è il tumore epatico benigno più frequente dopo l'angioma. E' di solito rilevata in modo occasionale, per lo più nelle donne in età fertile, anche se si può riscontrare in entrambi i sessi e ad ogni età. I soggetti portatori raramente sono sintomatici, nonostante l'FNH possa essere causa di dolore ai quadranti addominali superiori. Nella gestione dell'FNH il problema clinico principale è rappresentato dalla difficoltà di differenziarla dalle altre lesioni epatiche ipervascolarizzate, come l'adenoma, l'epatocarcinoma o le metastasi ipervascolari, tuttavia utilizzando le opportune tecniche diagnostiche è oggi possibile evitare il ricorso ad esami invasivi. La Risonanza Magnetica (RM) ha una sensibilità e una specificità superiori rispetto a quelle dell'ecografia convenzionale e della Tomografia Assiale Computerizzata (TC) per la diagnosi di FNH. L'uso dell'angioecografia perfusionale (CEUS) e dell'eco-Doppler può tuttavia aumentare in modo significativo la confidenza diagnostica

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“…Inflammatory pseudotumors (IPTs) are the most common among such processes. They are usually found in children and young adults and are most frequently found in the lungs, but they can occur in almost any organ, especially within the abdomen [1][2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Abdominal inflammatory masses mimicking neoplasia in children—experience of two centers

et al. 2005

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Despite progress in modern imaging, some inflammatory masses are difficult to distinguish clinically from neoplastic processes. In such cases the pathology report has a great distinctive value, but even then the final diagnosis may be difficult to reach. Eight patients with abdominal tumors of inflammatory origin were treated in two institutions, the Department of Pediatric Surgery of the Medical University of Gdansk, Poland, and Helios Center of Pediatric Surgery in Berlin, Germany, during the last 10 years. Four tumors were located in the pelvis, two in the liver, and two in the colonic mesentery. Five of them were inflammatory pseudotumors (two subclassified as inflammatory fibrosarcoma), one had nonspecific inflammatory changes, one was diagnosed as idiopathic retroperitoneal fibrosis, and one was diagnosed as bacillary angiomatosis. All patients underwent surgical tumor biopsy, excisional in four and incisional in four. All but two children underwent macroscopically complete tumor excision (four primarily, two secondarily). In one case the tumor resolved with antibiotherapy. Surgery in retroperitoneal masses was often extensive and associated with significant complications because of invasive tumor growth. In conclusion, intraabdominal inflammatory lesions may closely mimic neoplasia in children. Clinical doubts result in repeated biopsies, and for this reason excisional biopsy should be preferred. In some cases, when excisional biopsy is not feasible due to invasive growth of the tumor, delayed complete mass excision should follow, despite occasional significant morbidity. The etiology and exact nature of inflammatory pseudotumors are still obscure, and it is unknown whether they represent inflammatory lesions or true neoplasia.

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Inflammatory pseudotumor of the liver: Case report and review of the literature

Cited by 50 publications

References 19 publications

Inflammatory pseudotumor: A diagnostic dilemma in cytopathology

Inflammatory pseudotumor: A diagnostic dilemma in cytopathology

Diagnosis and management of hepatic focal nodular hyperplasia

Abdominal inflammatory masses mimicking neoplasia in children—experience of two centers

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