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

Abstract

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.

Magnetic resonance imaging of inflammatory pseudotumor of the liver: a 2021 systematic literature update and series presentation

“…Fluorodeoxyglucose-positron emission tomography can also induce the diagnosis of malignancy due to the often high glucose uptake of IPTL [ 12 ]. When more nodules are present, it is possible to find a different glucose uptake by each nodule due to the different temporal stages of each nodule [ 50 ].…”

Distinguishing Hepatocellular Carcinoma From Hepatic Inflammatory Pseudotumor Using a Nomogram Based on Contrast-Enhanced Ultrasound

“…The net benefit notably increased with these clinical features added in the nomogram. AFP is a specific biomarker for HCC that has been widely used (23) with elevated AFP and AFP-L3 that mimics the characteristics of HCC (5). However, AFP is still a significant indicator for HCC in our model.…”

“…Hepatic IPT often presents with atypical symptoms such as abdominal pain, fever, and nonspecific lab results, and therefore diagnosis is challenging and largely relies on the pathologic findings (2,3). Moreover, IPT has a potential for mimicking malignant tumors, such as hepatocellular carcinoma (HCC) (4)(5)(6). Around 60% of IPT patients had to receive surgery because a malignancy was suspected even with the imaging results (3).…”

“…To the best of our knowledge, there has been no study that develops a model to distinguish between HCC and IPT. Due to the rareness of IPT, most literatures described IPT in case reports (5,6).…”