Inflammatory pseudotumor of the liver. Clinicopathologic study and review of the literature

Abstract

Clinicopathologic analysis of nine patients with inflammatory pseudotumor of the liver was reported. The age of the patients varied from 22 to 83 years old, with a male to female ratio of 8 to 1. They complained of intermittent fever and abdominal pain, and laboratory data on admission suggested an inflammatory process. The solitary or multiple, well-defined space-occupying lesions were displayed by recently advanced imaging techniques. Partial hepatectomy, laparotomy, needle biopsy, or autopsy was performed in all nine patients with diagnoses of hepatocellular carcinoma, metastatic liver tumor, or liver abscess. Histologically, these lesions were composed of dense hyalinized fibrosis and/or infiltrating inflammatory cells constituting large numbers of foamy histiocytes, lymphocytes, and plasma cells. Obliterating phlebitis of relatively large branches of the portal vein was found, thus providing a diagnostic clue to distinction from the primary hepatic cancer by imagings. Considering the clinicopathologic features and the patients' histories, in which four patients had been in the Southeast Asian countries or India, it is possible that infection of microorganisms through the portal vein could participate in these lesions as a cause. Two patients died of causes probably related to this lesion, indicating poor prognosis in some patients, in contrast to the generally fair prognosis of previously published cases.

Pathological classification of hepatic inflammatory pseudotumor with respect to IgG4-related disease

“…1,2 In a large series of 84 extrapulmonary inflammatory pseudotumors reported by Coffin et al, just 7 (8%) were located in the liver. 3 Inflammatory pseudotumors are characterized histologically by the proliferation of fibroblasts or myofibroblasts and inflammatory cell infiltration, irrespective of their organs of origin.…”

“…3 Inflammatory pseudotumors are characterized histologically by the proliferation of fibroblasts or myofibroblasts and inflammatory cell infiltration, irrespective of their organs of origin. [1][2][3][4][5] The inflammatory cells mainly consist of polyclonal lymphocytes and plasma cells. Bacterial or viral infections and autoimmune reactions were suggested in the development of some inflammatory pseudotumors, although the etiology and pathogenesis of hepatic inflammatory pseudotumor have not been well documented and might differ among cases.…”

Inflammatory pseudotumor of the liver: sonographic and computed tomographic features with complete regression.

“…3,5,7,10,11 Posterior enhancement was observed in one case, and another case showed thickening of a portal vein draining the lesion. 9,10 Although some reports mention a decrease in the size of the lesions as shown by follow-up imaging studies, we found no other case in the literature with imaging before, during, and after. 8 Moreover, in our follow-up ultrasonographic and CT scans the caudate lobe appears to have shrunk.…”

Inflammatory pseudotumours of the liver: A spectrum of presentation and management options

“…Sakai et al 16 reported on a series of five patients with IPT. CT appearances were of low-density lesions with irregular delayed enhancement as also described by other authors 4,12,16,18,19 . Seki et al 20 , demonstrated peripheral enhancement of IPT in the early phases of dynamic CT in three patients.…”