Intrahepatic Cholangiocarcinoma Mimicking Hepatic Inflammatory Pseudotumor

Kitajima, Kumiko; Shiba, Hiroaki; Nojiri, Takuya; Uwagawa, Tadashi; Ishida, Yuichi; Ichiba, Noriatsu; Yanaga, Katsuhiko

doi:10.1007/s11605-006-0071-1

Cited by 19 publications

(18 citation statements)

References 11 publications

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“…Gd-enhancement MRI showed poorly defined peripheral rim-like enhancement at arterial phase (77.8%). However, other focal lesions such as atypical HCC, intrahepatic CC, metastatic tumors, or abscess might show similar enhancement patterns during CT or MRI 11,12. Previous studies reported IPTs of the liver mimicking malignant lesions such as intrahepatic CC, lymphoma, metastatic cancer, and HCC 11-13.…”

Section: Discussionmentioning

confidence: 98%

“…However, since most previous studies were descriptive ones involving only small numbers of patients, clinical features and image findings of this rare condition remains uncertain. Despite recent progress in diagnostic ability of radiologic study, it is difficult to differentiate IPT of liver from malignant tumor such as atypical hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CC) and metastatic cancer11,12 or liver abscess showing incomplete liquefaction and granulation 10…”

Section: Introductionmentioning

confidence: 99%

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Clinical Features, Image Findings, and Prognosis of Inflammatory Pseudotumor of the Liver: A Multicenter Experience of 45 Cases

et al. 2014

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Background/AimsInflammatory pseudotumor (IPT) of the liver is a rare disease characterized by chronic infiltration of inflammatory cells. However, the clinical characteristics and outcomes of IPT remain uncertain.MethodsClinical features, image findings, and outcomes of 55 patients with histologically proven IPT were evaluated.ResultsThey consisted of 26 men and 19 women with median age of 65 years. Serum carcinoembryonal antigen and carbohydrate antigen 19-9 levels were normal in 42 patients (93.3%). Enhanced CT scans indicated poorly defined peripheral enhancement (82.5%) at the arterial phase and poorly defined hyperattenuating lesions with internal hypoattenuating areas at the equilibrium phase (77.0%). Gadolinium-enhancement MRI revealed poorly defined peripheral rim-like enhancement (77.8%). Ten patients underwent surgical resection and 35 were treated conservatively with or without antibiotics. No recurrence was noted after surgical resection during follow-up (1 to 48 months). In all patients who received conservative treatment, complete resolution or size reduction was noted during follow-up (1 to 192 months).ConclusionsCT and MRI provide clues to the diagnosis of IPT in patients with liver masses and normal tumor markers. However, due to the lack of pathognomonic findings, the clinician's suspicion and histological diagnosis are necessary to make an accurate diagnosis of IPT.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Clinical Features, Image Findings, and Prognosis of Inflammatory Pseudotumor of the Liver: A Multicenter Experience of 45 Cases

et al. 2014

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“…Peripheral cholangiocarcinoma might have the imaging features of a heterogeneous mass with delayed enhancement, and cannot be completely excluded solely by imaging. Kitajima et al [37] postulated the use of diffusion-weighted imaging (DWI) with a low b value to differentiate IPT from cholangiocarcinoma because IPT demonstrates higher signal than cholangiocarcinoma. Some atypical IPTs may present with arterial enhancement, and are difficult to differentiate from hepatocellular carcinomas (HCCs).…”

Section: Discussion and Reviewmentioning

confidence: 99%

Uncommon liver tumors

Chiu²,

Yeh³

et al. 2016

Medicine

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Background:Beside hepatocellular carcinoma, metastasis, and cholangiocarcinoma, the imaging findings of other relatively uncommon hepatic lesions are less discussed in the literature. Imaging diagnosis of these lesions is a daily challenge. In this article, we review the imaging characteristics of these neoplasms.Methods:From January 2003 to December 2014, 4746 patients underwent liver biopsy or hepatic surgical resection in our hospital. We reviewed the pathological database retrospectively. Imaging of these lesions was reviewed.Results:Imaging findings of uncommon hepatic lesions vary. We discuss the typical imaging characteristics with literature review. Clinical and pathological correlations are also described. Primary hepatic lymphoma consists only of 1% of the extranodal non-Hodgkin lymphoma, and is defined as the one involving only the liver and perihepatic lymph nodes within 6 months after diagnosis. Combined hepatocellular and cholangiocarcinoma (cHCC-CC) shares some overlapping imaging characteristics with both HCC and cholangiocarcinoma because of being an admixture of them. Angiosarcoma is the most common hepatic mesenchymal tumor and is hypervascular in nature. Inflammatory pseudotumor is often heterogeneous on ultrasonography and with enhanced septations and rims in the portovenous phase after contrast medium. Angiomyolipoma (AML) typically presents with macroscopic fat components with low signal on fat-saturated magnetic resonance imaging (MRI) and presence of drainage vessels. Intraductal papillary neoplasm of the bile duct (IPNB) is thought of as a counterpart to the pancreatic intraductal papillary mucinous neoplasm. Most of the IPNBs secrete mucin and cause disproportional dilatation of the bile ducts. Mucinous cystic neoplasm (MCN) contains proteinaceous and colloidal components without ductal communication and characterizes with hyperintensity on T1-weighted imaging. Other extremely rare lesions, including epithelioid hemangioendothelioma and inflammatory pseudotumor-like follicular dendritic cell sarcoma, are also discussed. Hepatoblastoma and mesenchymal hamartoma, mostly in children, are also briefly reviewed as well.Conclusion:It is important for radiologists to be familiar with the typical imaging features of the uncommon hepatic neoplasms. If imaging findings are not typical or diagnostic, further biopsy is required.

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“…However, such a diagnosis can be difficult because of the absence of specific radiologic signs and variable radiologic findings reflecting the evolutionary stage of IPT. 6 Kitajima et al 7 have reported that high intensity by diffusion magnified-weighted imaging with low B value is one of the most decisive radiologic features for the diagnosis of IPT by reflecting high perfusion of water. Percutaneous needle biopsy of a suspicious lesion might be useful for making an accurate diagnosis of IPT.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Inflammatory Pseudotumor With Elevated Serum CA19-9 Level Mimicking Liver Metastasis From Rectal Cancer: Report of a Case

Shirai

Shiba

Fujiwara

et al. 2013

International Surgery

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Inflammatory pseudotumor (IPT) of the liver is rare, and differential diagnosis from malignant tumors is difficult. We herein report a case of IPT of the liver with marked elevation of carbohydrate antigen 19-9 (CA19-9). A 72-year-old woman, who underwent low anterior resection for rectal cancer, had low-grade fever and epigastric pain. The patient has well-controlled idiopathic thrombocytopenic purpura (ITP) with steroid maintenance treatment. Abnormal laboratory findings included serum carcinoembryonic antigen of 15.9 ng/mL and CA19-9 up to 14,632 U/mL. Computed tomography revealed a low-density lesion, and magnetic resonance imaging demonstrated a high intensity lesion on T1, T2-weighted, and diffusion-weighted images (55 3 22 mm in the Couinaud's segment 4 of the liver). However, 1 month after the appearance of the symptom, serum level of CA19-9 suddenly decreased to 37 U/mL. The tumor decreased spontaneously to 20 3 10 mm. Seven months later, the tumor had reduced to 18 3 11 mm. With a diagnosis of IPT, the patient remains well without regrowth of the tumor at 1 year follow-up after CA19-9 decrease to normal limits.

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Intrahepatic Cholangiocarcinoma Mimicking Hepatic Inflammatory Pseudotumor

Cited by 19 publications

References 11 publications

Clinical Features, Image Findings, and Prognosis of Inflammatory Pseudotumor of the Liver: A Multicenter Experience of 45 Cases

Clinical Features, Image Findings, and Prognosis of Inflammatory Pseudotumor of the Liver: A Multicenter Experience of 45 Cases

Uncommon liver tumors

Hepatic Inflammatory Pseudotumor With Elevated Serum CA19-9 Level Mimicking Liver Metastasis From Rectal Cancer: Report of a Case

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