Inflammatory pseudotumor of the liver in a patient with chronic hepatitis C: Difficulty in differentiating it from hepatocellular carcinoma

Abstract

A case of an inflammatory pseudotumor of the liver in a 75-year-old female with chronic hepatitis C whose radiologic features simulated that of hepatocellular carcinoma (HCC) is presented. On imaging studies, hypervascularity by CO2 ultrasound (US) angiography, enhancement at an early phase and isodensity at a late phase by incremental dynamic computed tomography (CT), perfusion defect by CT during arteriography (CTAP), and clinical background of hepatitis C virus (HCV) infection strongly suggested HCC. A US-guided needle biopsy revealed a mainly diffuse and polyclonal proliferation of lymphocytes positive for leukocyte common antigen (pan-lymphocyte cells), L-26 (B cell lymphocytes), and UCHL-1 (T cell lymphocytes), negative for both kappa and lambda light chains and sparsely distributed neutrophils and histiocytes. No lymphoid follicles were observed. The liver tissue around this tumor showed chronic hepatitis with mild activity and mild fibrosis. These histopathologic findings suggested that the diagnosis of inflammatory pseudotumor of the liver was tenable. As it is difficult to differentiate between inflammatory pseudotumor of the liver and HCC by imaging studies alone, supplemental biopsy, where possible, should be obtained when diagnostic imaging of tumors suggesting HCC is carried out. We emphasize that histopathology is a true gold standard in the diagnosis of this disease.

Inflammatory Pseudotumor of the Liver Masquerading as Hepatocellular Carcinoma After a Hepatitis B Virus Infection: Report of a Case

“…23,24 Our patient had an antecedent history of HBV infection; however, there is no information available about the relationship between this viral infection and hepatic IPT. On the other hand, two cases of IPT following hepatitis C virus infection have been described, 25,26 although the specific mechanisms of IPT developing after hepatitis virus infection were not discussed.…”

Hepatic Inflammatory Pseudotumor Associated with Xanthogranulomatous Cholangitis Mimicking Cholangiocarcinoma

“…For instance, cases of IPT have been reported in patients with viral infections (6), including the hepatitis B or C virus (7)(8)(9). Still, there is no clear evidence of an association between hepatic IPT and the detection of infectious organisms.…”

“…Hence, attempting to make the preoperative diagnosis based on the findings of a percutaneous needle biopsy is important, although needle biopsies lead to the diagnosis of IPT in only a few cases (8,13). Kim et al reported a case of IPT diagnosed according to a needle biopsy in a patient with hepatitis C and concluded that supplemental biopsies should be obtained in order to differentiate between IPT of the liver and hepatocellular carcinoma (HCC) (8).…”

Inflammatory pseudotumor of the liver in a patient with rectal cancer: a case report

“…There are a few reports on the use of CTA and CTAP for IPT [2], in which the vascularity of the lesion is described. Because the vascular distribution of IPT varies, CTA and CTAP findings on this disease entity are nonspecific; however, CTAP may aid in detecting the lesion.…”

“…In previous reports on this entity, the difficulty associated with its radiological diagnosis was described [1,2,3] and the diagnosis in most cases was confirmed during surgery and a biopsy [4]. Patients with IPT commonly have symptoms and laboratory data suggestive of inflammation [1,3,4], but in the absence of a clinical abnormality, it is difficult to arrive at a definitive diagnosis.…”