Inflammatory Pseudotumor of the Liver: A Rare Case of Recurrence Following Surgical Resection

Chang, Silvia D.; Scali, Elena P.; Abrahams, Zuheir; Tha, Susan; Yoshida, Eric M.

doi:10.3941/jrcr.v8i3.1459

Cited by 16 publications

(8 citation statements)

References 29 publications

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“…In the present case, the preoperative diagnosis was HCC because of the patient’s background chronic liver disease, elevated serum AFP and AFP-L3, and radiological findings such as high–low pattern. In hepatic IPTs, although inflammatory markers, including C-reactive protein and leukocyte count, and liver enzymes are sometimes elevated, tumor markers are usually normal [ 5 ]. AFP is a well-known tumor marker for HCC [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…On contrast-enhanced CT, IPT shows a variable pattern of enhancement. Generally, it shows peripheral enhancement in the delayed phase, similar to metastatic liver tumors [ 3 , 5 ]. However, some studies have reported lesions with early phase enhancement and washout in the delayed phase, similar to HCC [ 8 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…HCC is also known to have different imaging findings on FDG-PET depending on the degree of differentiation [ 13 , 14 ]. In addition, hepatic IPT is usually detected as a solitary tumor [ 3 , 5 , 8 , 11 , 12 ]. In contrast, our patient had multiple IPTs in the liver, and it was reported that some patients with multiple lesions had both IPTs and malignant tumors [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Multiple hepatic inflammatory pseudotumors with elevated alpha-fetoprotein and alpha-fetoprotein lectin 3 fraction with various PET accumulations: a case report

et al. 2021

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multiple hepatic inflammatory pseudotumors with elevated alpha-fetoprotein and alpha-fetoprotein lectin 3 fraction with various PET accumulations: a case report

et al. 2021

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“…Culture samples can also be obtained by biopsy in cases with a suspected infectious background [ 2 , 3 ]. In this sense, IgG4-related hepatic IPT features fairly unique histology; that is to say abundant IgG4-positive plasma cell infiltration (>10 cells/HPF in biopsy and >50 cells in surgical materials) [ 8 ], storiform fibrosis, and obliterative phlebitis [ 8 , 10 , 17 ]. The sample obtained from current patient contained diagnostic items fulfilling the criteria of possible IgG4-RD [ 8 , 10 ] and percutaneous needle biopsy is thought to be an effective diagnostic tool for IgG4-related hepatic IPT.…”

Section: Discussionmentioning

confidence: 99%

A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment

et al. 2016

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BackgroundHepatic 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 presentationA 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.ConclusionThe 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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“…Almost 100% of the IPT-like FDC tumors have always been proven to be associated with the EBV infection [18]. Although IPT-like FDC Sarcoma of the liver is extremely uncommon, most published cases showed typical histological characteristics, consistent with EBV infection and has a good prognosis after surgical resection of the tumor [1,19].…”

Section: Introductionmentioning

confidence: 99%

Inflammatory Pseudo Tumor-Like Follicular Dendritic Cell Sarcoma of the Liver with Hepatic Lymphoma History:A Case Report and Literature Review

Wang

Chen

et al. 2021

Preprint

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Background:Inflammatory Pseudo Tumor (IPT)-like Follicular Dendritic Cell (FDC) Sarcoma of the liver is a very rare disease and occurs mostly in the lymph nodes. Till now, only 19 cases were reported in the English literature. However, the coexistence of IPT-like Sarcoma and Non-Hodgkin’s Lymphoma(NHL) in the same patient has never been reported.Case presentation:We reported a case of a 47-year-old male patient who had a history of Hepatitis B virus (HBV) infection and presented with right upper abdominal discomfort. Nineteen years ago, he underwent liver resection of segment VII for Hepatic Non-Hodgkin Lymphoma (B-cell lymphoma). Serum alpha fetoprotein (AFP) level was normal. However, Imaging studies revealed a well-circumscribed, solid mass in the right hepatic lobe and was diagnosed as (Hepatocellular Carcinoma) HCC or Hepatic Lymphoma preoperatively. Right hemi-hepatectomy was performed on this patient. Histological report showed features of a mixture of chronic inﬂammatory cells and variable amounts of spindle cells. Also, Immuno-Histo-Chemical (IHC) studies demonstrated that all the tumor cells showed strong nuclear in situ labeling for EBV-encoded small RNAs (EBER) and strongly positive stainings with CD21 and CD35. The patient is still disease free after a follow-up of 40 months. Conclusions:To our knowledge, this is the first report demonstrating Hepatic IPT-like FDC Sarcoma in a patient with Primary Hepatic Non-Hodgkin Lymphoma history. In regards to treatment, complete surgical resection should be performed and would acquire excellent long-term outcomes.

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Inflammatory Pseudotumor of the Liver: A Rare Case of Recurrence Following Surgical Resection

Cited by 16 publications

References 29 publications

Multiple hepatic inflammatory pseudotumors with elevated alpha-fetoprotein and alpha-fetoprotein lectin 3 fraction with various PET accumulations: a case report

Multiple hepatic inflammatory pseudotumors with elevated alpha-fetoprotein and alpha-fetoprotein lectin 3 fraction with various PET accumulations: a case report

A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment

Inflammatory Pseudo Tumor-Like Follicular Dendritic Cell Sarcoma of the Liver with Hepatic Lymphoma History:A Case Report and Literature Review

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