Inflammatory pseudotumors of the liver: Importance of a multimodal approach with the insistance of needle biopsy

Nigam, Neha; Rajani, Shikha Singh; Rastogi, Archana; Patil, Anupama; Agrawal, Nikhil; Sureka, Binit; Arora, Asit; Bihari, Chhagan

doi:10.4103/jlp.jlp_63_19

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…Inflammatory pseudotumors is another potential diagnostic pitfall in which hepatocytes with reactive atypia may be mistaken for HCC. Caution should be exercised in making a diagnosis of HCC on an aspirate with an extensive inflammatory infiltrate, particularly with plasma cell prominence or granulomatous features 101,102 …”

Section: Hepatocyte Atypia In the Cirrhotic Livermentioning

confidence: 99%

Significance of hepatocyte atypia in liver fine needle aspiration

Shyu

Ali

2021

Diagnostic Cytopathology

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Fine needle aspiration (FNA) of the liver is frequently the diagnostic procedure of choice for sampling hepatic lesions. One of the main diagnostic challenges in the interpretation of liver FNA is distinguishing dysplastic lesions and well‐differentiated hepatocellular carcinoma (WD‐HCC) from benign processes, as they share significant cytomorphologic overlap. Furthermore, the diagnosis of HCC often requires evaluation of stroma for invasion, which may not be present on cytology and small needle biopsy specimens. A reporting system for liver cytopathology has yet to be instituted. Without standardized and well‐defined criteria for hepatocyte atypia, we recommend limiting the use of atypia in evaluation of liver FNA specimens to describe a diagnosis of exclusion, in which all known benign and neoplastic processes have been ruled out. The cytologic findings on the FNA of a liver nodule may be best reported as atypical hepatocytes in the absence of a core needle biopsy or cell block sufficient to render a definitive diagnosis of HCC.

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Section: Hepatocyte Atypia In the Cirrhotic Livermentioning

confidence: 99%

Significance of hepatocyte atypia in liver fine needle aspiration

Shyu

Ali

2021

Diagnostic Cytopathology

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“…Inflammatory pseudotumor is a term used to designate inflammation-rich tumefactive lesions 1. Of note, there has been much debate regarding the etiology of lesions previously characterized as “inflammatory pseudotumor,” particularly since the older pediatric literature sometimes used the term synonymously with “inflammatory myofibroblastic tumor.”2 In addition, before the recognition of IgG4-related disease, this distinct mass-forming fibroinflammatory process was also classified as inflammatory pseudotumor 3.…”

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confidence: 99%

Fibrohistiocytic Variant of Hepatic Pseudotumor

Arora

Anderson²,

Neyaz³

et al. 2021

American Journal of Surgical Pathology

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Inflammatory pseudotumor is a term used to designate inflammation-rich tumefactive lesions. Following the exclusion of specific entities such as IgG4-related disease and other neoplastic entities previously included in this entity, the majority of hepatic pseudotumors show a prominent fibrohistiocytic inflammatory reaction and have been previously categorized as fibrohistiocytic variant of hepatic pseudotumor (FHVHPT). The goal of this study was to examine the clinical, radiologic, histologic, and etiologic aspects of this entity. After excluding neoplastic diseases, we identified 30 patients with FHVHPT from 3 institutions between 2009 and 2019. We extracted demographic and clinical data, liver function tests as well as culture results and radiologic information. Hematoxylin and eosin–stained slides were reviewed for pattern of inflammation as well as its cellular composition. Immunohistochemistry for IgG4 and IgG was performed in all cases. The mean age of the 30 lesions characterized as FHVHPT was 56 years (range: 23 to 79 y). Nineteen patients showed solitary lesions; 11 were multiple. The mean size of the lesion was 3.8 cm (range: 1 to 7.5 cm). On imaging, a neoplastic process or metastasis was the leading diagnostic consideration (n=15, 50%). The most common symptom was abdominal pain (n=14/30); 8 patients presented with symptoms compatible with an infectious process, including fever. The inflammatory infiltrate was dominated by lymphocytes and plasma cells, and in most cases, a prominent histiocytic infiltrate (22/30). Neutrophils were identified in 12 cases, with microabscess noted in 8. Storiform pattern of fibrosis was seen in 14/30 cases; obliterative phlebitis was not identified. Culture identified a microorganism in 4 of 9 cases evaluated. The mean IgG4 count was 9.3 per HPF (range: 0 to 51) with 9 of the 26 (35%) biopsies showing >10 IgG4 positive plasma cells per HPF. The mean IgG4 to IgG ratio was 8% (range: 8% to 46%). A hepatectomy was performed in 4 cases. On broad spectrum antibiotics (n=14) the lesions either resolved or decreased in size. Eight patients did not receive specific therapy, nevertheless, the lesion(s) resolved spontaneously in 6 cases, remained stable or decreased in size in 2 cases. Notably, none of these patients showed evidence of a hepatic recurrence. FHVHPT, a tumefactive lesion that mimics hepatic neoplasia, is histologically characterized by a fibrohistiocytic infiltrate. In the majority of patients FHVHPT represents the organizing phase of hepatic abscess and can be successfully managed with antibiotic therapy.

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