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Taiymi A, Meryem N, Bouziane M, Zazour A, Kharrasse G, Khannoussi W, Ismaili Z. Abdominal Inflammatory Myofibroblastic Tumour Presenting as a Pancreatic Mass: A Case Report. Cureus 2023; 15:e41213. [PMID: 37525776 PMCID: PMC10387333 DOI: 10.7759/cureus.41213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
An abdominal inflammatory myofibroblastic tumor (AIMT), is a rare benign tumor composed of inflammatory and other mesenchymal cells. It can affect the entire body, predominantly in children and young adults. The diagnosis is challenging considering the wide clinical presentation and can often be mistaken for malignant tumors. We report a rare case of a 46-year-old female patient, who presented with intermittent abdominal pain weight loss, and an abdominal palpable mass. Abdominal ultrasound found a well-defined 18 cm, rounded mass, with solid and cystic components. Abdominal CT demonstrated a well-defined, hypodense, retro gastric mass of 20 cm, with thickened wall and heterogenous enhancement. The mass had contact with the pancreatic tail, transverse colon, spleen, left kidney pedicles, abdominal aorta, superior mesenteric vein, and mesaraic trunk with no invasion signs. The mass was initially thought to be pancreatic cancer, but given the large size, other diagnoses like sarcoma, lymphoma, or abdominal hydatid cyst were suggested. Endoscopic ultrasound found a rounded retro gastric mass of 18/12 cm, with a thickened wall and well-limited calcifications. The content was both cystic and solid with mobile vegetations, with no visible Doppler flow. The mass had contact with the body and tail of the pancreas, spleen hilum, the upper pole of the spleen, and the hepatic pedicle behind, with no invasion sign. After a multidisciplinary team meeting, a decision was taken to perform surgical resection with mass resection, distal splenopancreatectomy, and transverse and sigmoid colectomy. Pathological and immunostaining results were consistent with inflammatory pseudotumor. The postoperative recovery was uncomplicated. The patient remains asymptomatic with no obvious signs of metastasis or recurrence. AIMT represents a reel diagnostic challenge. Clinical symptoms are unspecific. Radiological and endoscopic features can often be mistaken for malignant tumors. Surgical management remains to be the best therapeutic option. We report a rare case of AIMT treated by surgery with complete resection. We suggested a long-term follow-up given the local recurrence risk.
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Affiliation(s)
- Afafe Taiymi
- Gastroenterology and Hepatology, Digestive Disease Research Laboratory, Mohammed First University, Oujda, MAR
| | - Nasiri Meryem
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
| | | | - Abdelkrim Zazour
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
| | - Ghizlane Kharrasse
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
- Gastroenterology and Hepatology, Digestive Disease Research Laboratory, Mohammed First University, Oujda, MAR
| | - Wafaa Khannoussi
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
- Gastroenterology and Hepatology, Digestive Disease Research Laboratory, Mohammed First University, Oujda, MAR
| | - Zahi Ismaili
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
- Gastroenterology and Hepatology, Digestive Disease Research Laboratory, Oujda, MAR
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Omer Mirghani M, Zia Z, Haytham Mawardi M, Almansouri Z, Ahmad N. IgG4-related inflammatory pseudotumor of the liver presenting as an incidental solitary liver mass. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2023. [DOI: 10.5348/100101z04mm2023cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Inflammatory pseudotumor is increasingly being recognized as a definitive pathological entity affecting many organ systems and often difficult to distinguish from malignancy. We report a case of a 48-year-old female who presented with right hypochondrial pain associated with nausea and vomiting and recent weight loss. An ultrasound scan demonstrated gallstones without evidence of cholecystitis and an incidental 1.5 cm mass in the left liver lobe. A computed tomography (CT) and a magnetic resonance imaging (MRI) scan described the mass suspicious of a malignant tumour. An ultrasound-guided biopsy confirmed a benign inflammatory mass with lymphoplasmacytic infiltration staining for IgG4 and no evidence of malignancy. The patient had an elevated serum IgG4 levels. The patient was kept under surveillance. She underwent a laparoscopic cholecystectomy and at 18 months following the initial presentation the patient remains asymptomatic with stable liver lesion on ultrasound scan.
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Affiliation(s)
- Mohammed Omer Mirghani
- Department of Surgery, Section of Hepatobiliary and Transplantation Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Zergham Zia
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Mohammad Haytham Mawardi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Zuhoor Almansouri
- Department of Anatomic Pathology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Niaz Ahmad
- Departmet of Surgery, Section of Hepatobiliary and Transplantation Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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3
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Ahmed M, Buti YJ, Bawahab A, Ghaly H, Elsayed R. Small Bowel Obstruction as a Result of Inflammatory Pseudotumor. Cureus 2022; 14:e28707. [PMID: 36204020 PMCID: PMC9527131 DOI: 10.7759/cureus.28707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 12/02/2022] Open
Abstract
Inflammatory pseudotumor is a rare benign neoplasm that has been described in nearly the entire body and is often mistaken for malignancy. The exact etiology remains unknown. We present a case of small bowel obstruction secondary to an inflammatory pseudotumor. The patient’s symptoms and radiological findings were very concerning for underlying malignancy. En-block resection was recommended to prevent a recurrence. We aim to shed light on this rare cause of small bowel obstruction.
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Geiselmann MT, Acampa DJ, Melamed J, Arif F, Takabe K, Seitelman E, Datta R, Gunasekaran G, Takahashi H. Immunoglobulin G4-Negative Inflammatory Pseudotumors of the Pancreas. World J Oncol 2022; 12:240-245. [PMID: 35059084 PMCID: PMC8734500 DOI: 10.14740/wjon1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 11/11/2022] Open
Abstract
Inflammatory pseudotumor (IPT) can occur in any organ, but rarely shows pancreatic involvement. While surgical excision has been recommended as the primary treatment for IPT of the pancreas in the past, some authors suggest observation while medical management often results in regression. Corticosteroids, nonsteroidal anti-inflammatory drugs and immunosuppressive therapy have been used to treat IPTs. Spontaneous regression has also been reported in IPT managed without surgical intervention. A 62-year-old female was evaluated for worsening abdominal pain and a mass in the neck of the pancreas that was identified on ultrasound. Further imaging with magnetic resonance imaging revealed a pancreatic mass with dilated pancreatic duct and an atrophic parenchyma of the pancreatic neck. Her serum tumor markers were not elevated. As this lesion appeared to be resectable pancreatic cancer based on cross-sectional imaging, no biopsy was performed prior to surgical resection. Distal pancreatectomy and splenectomy was recommended and the patient desired to proceed. Her recovery was uneventful with no postoperative complications, including pancreatic fistula. Final pathology revealed a lesion consistent with the diagnosis of immunoglobulin G4 (IgG4)-negative IPT without neoplasm. IPT of the pancreas is a difficult entity to diagnose and treat due to clinical and imaging characteristics closely resembling pancreatic adenocarcinoma. Biopsy with immunohistochemical analysis can be useful in diagnosing IPT; however, symptomatic lesions and concerning findings on cross-sectional imaging may warrant more definitive surgical intervention.
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Affiliation(s)
- Matthew T Geiselmann
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Daniel J Acampa
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Joshua Melamed
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Farzana Arif
- Department of Pathology, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA.,Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Eric Seitelman
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Rajiv Datta
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Ganesh Gunasekaran
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA.,Department of Surgery, Division of HPB Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Hideo Takahashi
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
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5
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Koiwai A, Hirota M, Satoh M, Takasu A, Meguro T, Endo K, Kogure T, Murakami K, Murakami K, Satoh K. Immunoglobulin G4-Related Hepatic Inflammatory Pseudotumor Diagnosed with Endoscopic Ultrasound-Guided Fine-Needle Biopsy. Case Rep Gastroenterol 2021; 15:488-494. [PMID: 34616245 PMCID: PMC8454245 DOI: 10.1159/000516687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022] Open
Abstract
A 71-year-old man with obstructive jaundice was referred to our department. He underwent cholangiojejunostomy 15 years ago for palliative drainage. At that time, he had obstructive jaundice caused by an unresectable pancreatic head tumor. Contrast-enhanced computed tomography (CE-CT) now revealed a mass with low enhancement in the hepatic hilum that occluded the hilar bile duct and infiltrated extensively along the portal vein and hepatic artery. CE-CT also showed marked atrophy of the left hepatic lobe. No swelling or tumors were observed in the pancreas. Serum immunoglobulin G4 (IgG4) levels were as high as 465 mg/dL. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) was performed targeting the hepatic hilar lesion. Immunohistological results of the biopsy specimens suggested that the lesion was an IgG4-related hepatic inflammatory pseudotumor (IPT) with no atypical cells. Steroid treatment resulted in rapid clinical improvement. This case suggested the usefulness of EUS-FNB for diagnosing IgG4-related hepatic hilar IPT.
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Affiliation(s)
- Akinobu Koiwai
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Morihisa Hirota
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mari Satoh
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Atsuko Takasu
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takayoshi Meguro
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Katsuya Endo
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takayuki Kogure
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Keigo Murakami
- Division of Pathology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kazuhiro Murakami
- Division of Pathology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kennichi Satoh
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Maruno M, Imai K, Nakao Y, Kitano Y, Kaida T, Mima K, Hayashi H, Yamashita YI, Mikami Y, Baba H. Multiple hepatic inflammatory pseudotumors with elevated alpha-fetoprotein and alpha-fetoprotein lectin 3 fraction with various PET accumulations: a case report. Surg Case Rep 2021; 7:107. [PMID: 33913027 PMCID: PMC8081814 DOI: 10.1186/s40792-021-01188-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/18/2021] [Indexed: 01/08/2023] Open
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.
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Affiliation(s)
- Masataka Maruno
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Yosuke Nakao
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuki Kitano
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takayoshi Kaida
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kosuke Mima
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Kwag MH, Park JY, Jeong HW, Han JY, Lim JH, Kim YS, Park JW. Overlooked and Challenging Encounters–Inflammatory Pseudotumors in the Abdomen and Pelvis: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1121-1133. [PMID: 36238032 PMCID: PMC9431880 DOI: 10.3348/jksr.2019.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 11/15/2022]
Abstract
Inflammatory pseudotumors (IPTs) are uncommon, mass-forming lesions, predominantly involving the lung and orbit. Although the incidence of IPTs is rare in the abdomen and pelvis, they can be encountered as enhancing, soft-tissue lesions, mimicking malignancy or fibrosclerosing disease. Generally, they exhibit a wide range of nonspecific imaging features in various organs. Preoperative imaging diagnosis of IPTs in appropriate clinical settings may help determine proper patient management. In this article, we review radiologic findings of IPTs in the abdominopelvic cavity, including the liver, spleen, kidney, gastrointestinal tract, mesentery, pelvis, and retroperitoneum.
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Affiliation(s)
- Min Ha Kwag
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jin Young Park
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ji Yeon Han
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jong Heon Lim
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Seon Kim
- Department of Radiology, Yeungnam University Hospital, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jung Won Park
- Department of Radiology, Gimhaebokum Hospital, Gimhae, Korea
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Yang TL, Chang HC. Inflammatory Pseudotumor of the Liver. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_15_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Patel H, Nanavati S, Ha J, Shah A, Baddoura W. Spontaneous Resolution of IgG4-Related Hepatic Inflammatory Pseudotumor Mimicking Malignancy. Case Rep Gastroenterol 2018; 12:311-316. [PMID: 30022921 PMCID: PMC6047548 DOI: 10.1159/000490100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 12/16/2022] Open
Abstract
Hepatic inflammatory pseudotumor (IPT) is characterized by a well-circumscribed benign tumor mimicking or often mistaken for a malignant lesion. A 48-year-old male presented to the hospital with complaints of epigastric pain, with initial laboratory findings showing mildly elevated alkaline phosphatase (140 U/L) with normal AST, ALT, bilirubin, and lipase, a CD4 count of 384, and an HIV viral load of > 10 million copies. The total IgG level was elevated to 2,228 mg/dL (normal IgG4 level 114 mg/dL). Contrast-enhanced MRI of the abdomen showed heterogeneous mass-like infiltration in the right lobe of the liver measuring 9.6 cm. The liver mass was biopsied which showed dense collagenous fibrosis with abundant lymphoplasmacytic infiltrates with 18 IgG4-positive plasma cells per high-power field. The patient was not given any treatment for this IPT. For more than 1 year of follow-up triple-phase CT scan of the liver was repeated, which showed no liver mass. As radiological images of hepatic IPTs, including IgG4-related hepatic IPT, mimic liver malignancy, histological analysis of the biopsy remains the cornerstone for the diagnosis. Symptomatic patients with IgG4-related hepatic IPT have shown improvement with corticosteroid use; however, spontaneous resolution has also been reported like in the present case.
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Affiliation(s)
- Hiren Patel
- Department of Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Sushant Nanavati
- Department of Internal Medicine, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Jewook Ha
- Department of Internal Medicine, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Amol Shah
- Department of Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Walid Baddoura
- Department of Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
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10
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Gesualdo A, Tamburrano R, Gentile A, Giannini A, Palasciano G, Palmieri VO. A Diagnosis of Inflammatory Pseudotumor of the Liver by Contrast Enhaced Ultrasound and Fine-Needle Biopsy: A Case Report. Eur J Case Rep Intern Med 2017; 4:000495. [PMID: 30755918 PMCID: PMC6346893 DOI: 10.12890/2016_000495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/30/2016] [Indexed: 12/21/2022] Open
Abstract
Inflammatory pseudotumor (IPT) of the liver is a rare, benign lesion of unclear etiology, which may be misdiagnosed as hepatocellular carcinoma, cholangiocarcinoma, secondary tumor or abscess, because of its non-specific clinical, biochemical and radiologic findings. We present the case of a 48-old-year male in whom diagnosis of liver IPT was suspected by contrast enhanced ultrasound (CEUS) and confirmed by fine-needle liver biopsy. The diagnosis is in contrast to most of the literature reports in which the diagnosis was made only based on a surgical specimen.
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Affiliation(s)
- Annamaria Gesualdo
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico, Bari, Italy
| | - Rossana Tamburrano
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico, Bari, Italy
| | - Antonia Gentile
- Department of Emergency and Transplantation, Pathology Section, University of Bari, Policlinico, Bari, Italy
| | | | - Giuseppe Palasciano
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico, Bari, Italy
| | - Vincenzo O Palmieri
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico, Bari, Italy
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11
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Berumen J, McCarty P, Mo J, Newton K, Fairbanks T, Mekeel K, Hemming A. Combined liver transplant and pancreaticoduodenectomy for inflammatory hilar myofibroblastic tumor: Case report and review of the literature. Pediatr Transplant 2017; 21. [PMID: 28000317 DOI: 10.1111/petr.12846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 12/14/2022]
Abstract
IMT, previously known as IPT, is a relatively rare tumor that was originally described in the lungs, but case reports have reported the tumor in almost every organ system. Surgical resection is typically the mainstay of therapy; however, tumors have also been shown to respond to chemotherapy or anti-inflammatory therapy and some have spontaneously regressed. We present a literature review and case report representing the first documentation to date of liver transplant combined with PD for surgical resection of a myofibroblastic tumor non-responsive to medical therapy.
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Affiliation(s)
| | - Patrick McCarty
- University of California San Diego - Surgery, La Jolla, CA, USA
| | - Jun Mo
- University of California San Diego - Surgery, La Jolla, CA, USA
| | - Kimberly Newton
- University of California San Diego - Surgery, La Jolla, CA, USA
| | | | - Kristin Mekeel
- University of California San Diego - Surgery, La Jolla, CA, USA
| | - Alan Hemming
- University of California San Diego - Surgery, La Jolla, CA, USA
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12
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Hamzaoui L, Medhioub M, Mahmoudi M, Chelbi E, Bouzaidi K, Msadak Azouz M. Inflammatory pseudotumor of the liver. Presse Med 2016; 45:804-7. [PMID: 27476013 DOI: 10.1016/j.lpm.2016.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/24/2016] [Accepted: 06/16/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lamine Hamzaoui
- Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia.
| | - Mouna Medhioub
- Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - Moufida Mahmoudi
- Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - Emna Chelbi
- Hôpital Mohamed Tahar Maamouri, service d'anatomopathologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - Khaled Bouzaidi
- Hôpital Mohamed Tahar Maamouri, service de radiologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - Mohamed Msadak Azouz
- Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia
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13
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Dhuria S, Kwatra KS, Ghosh DN. Inflammatory myofibroblastic tumour of sigmoid mesocolon in a child. ANZ J Surg 2016; 88:E674-E676. [PMID: 27193458 DOI: 10.1111/ans.13625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/09/2016] [Accepted: 04/04/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Sumit Dhuria
- Department of Pediatric Surgery, Christian Medical College & Hospital, Ludhiana, India
| | | | - Dhruva Nath Ghosh
- Department of Pediatric Surgery, Christian Medical College & Hospital, Ludhiana, India
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14
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Obana T, Yamasaki S, Nishio K, Kobayashi Y. A case of hepatic inflammatory pseudotumor protruding from the liver surface. Clin J Gastroenterol 2015; 8:340-4. [PMID: 26412330 DOI: 10.1007/s12328-015-0605-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/05/2015] [Indexed: 12/17/2022]
Abstract
We report a case of a resected hepatic inflammatory pseudotumor (IPT) protruding from the liver surface. A 69-year-old male with diabetes mellitus was admitted to hospital for investigation of an hepatic mass. An irregularly shaped, low-echoic mass measuring 21 × 18 mm was identified by ultrasound in S6. On computed tomography, the tumor appeared to be growing extrahepatically. After contrast enhancement, the lesion showed persistent peripheral enhancement, while the central part was hypoenhanced. On T2-weighted magnetic resonance imaging (MRI), the central portion of the lesion was hyperintense compared with the periphery. EOB-enhanced MRI revealed the mass to be being hypointense in contrast to the surrounding liver parenchyma in the hepatobiliary phase. On diffusion-weighted images, the lesion was hyperintense. Percutaneous biopsy was not attempted to avoid tumor cell dissemination. The patient underwent partial hepatectomy because of suspected malignancy. Histopathological examination of the resected specimen revealed fibrotic tissue and abundant vessels in the periphery, while a massive infiltration of inflammatory cells and fewer vessels were observed in the center. The patient was finally diagnosed with hepatic IPT of the fibrohistiocytic type.
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Affiliation(s)
- Takashi Obana
- Department of Gastroenterology, Kyojinkai Komatsu Hospital, 11-6 Kawakatsu-cho, Neyagawa City, Osaka Prefecture, 572-8567, Japan.
| | - Shuuji Yamasaki
- Department of Gastroenterology, Kyojinkai Komatsu Hospital, 11-6 Kawakatsu-cho, Neyagawa City, Osaka Prefecture, 572-8567, Japan
| | - Kazushi Nishio
- Department of Surgery, Kyojinkai Komatsu Hospital, Neyagawa, Japan
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Mulki R, Garg S, Manatsathit W, Miick R. IgG4-related inflammatory pseudotumour mimicking a hepatic abscess impending rupture. BMJ Case Rep 2015; 2015:bcr-2015-211893. [PMID: 26392451 DOI: 10.1136/bcr-2015-211893] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 50-year-old man presenting with sudden onset right upper quadrant pain and no constitutional symptoms was found to have two necrotic liver masses on imaging, consistent with hepatic abscesses unresponsive to systemic antibiotics and percutaneous drainage. The patient deteriorated and developed symptoms consistent with impending rupture. He therefore subsequently underwent right hepatic segmentectomy. All cultures were negative and histopathology confirmed IgG4 related disease/inflammatory pseudotumour of the liver. Postoperatively, the patient was asymptomatic with no IgG4 disease activity in other organs.
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Affiliation(s)
- Ramzi Mulki
- Department of Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shivani Garg
- Department of Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
| | - Wuttiporn Manatsathit
- Department of Gastroenterology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ronald Miick
- Department of Pathology, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA
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16
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Zhang Y, Lu H, Ji H, Li Y. Inflammatory pseudotumor of the liver: A case report and literature review. Intractable Rare Dis Res 2015; 4:155-8. [PMID: 26361568 PMCID: PMC4561246 DOI: 10.5582/irdr.2015.01021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 12/21/2022] Open
Abstract
Reported here is the case of a 55-year-old man who had tarry stools for 3 days before he was seen at this Department. The man had weight loss and an intermittent fever for 3 months prior. Histopathology revealed an inflammatory pseudotumor of the liver. This case is reported here along with a review of the literature. Nine days after surgery, the patient passed bright red blood (150 mL) in the stool with no clear trigger. A colonoscopy a month later revealed no abnormalities. This is a rare report of an inflammatory pseudotumor featuring intractable bleeding. An inflammatory pseudotumor of the liver is a rare condition, and differentiating this pseudotumor from hepatic space-occupying lesions is crucial. An inflammatory pseudotumor of the liver may spontaneously regress and mimic other liver tumors. The treatment of choice for this pseudotumor is still surgical resection, and this is especially true for patients with severe symptoms or an indeterminate diagnosis.
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Affiliation(s)
- Yafei Zhang
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Hongwei Lu
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Hong Ji
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Yiming Li
- Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
- Address correspondence to: Dr. Yiming Li, Department of General Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 157 West 5th Road, Xi'an 710004, People's Republic of China. E-mail:
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17
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Belghiti J, Cauchy F, Paradis V, Vilgrain V. Diagnosis and management of solid benign liver lesions. Nat Rev Gastroenterol Hepatol 2014; 11:737-49. [PMID: 25178878 DOI: 10.1038/nrgastro.2014.151] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
More and more asymptomatic benign liver tumours are discovered incidentally and can be divided into regenerative lesions and true neoplastic lesions. The most common regenerative lesions include hemangioma, focal nodular hyperplasia and inflammatory pseudotumours of the liver. Neoplastic lesions include hepatocellular adenomas and angiomyolipomas. Regenerative lesions rarely increase in volume, do not yield a higher risk of complications and usually do not require treatment. By contrast, hepatocellular adenomas and angiomyolipomas can increase in volume and are associated with a risk of complications. Large hepatocellular adenomas (>5 cm in diameter) are undoubtedly associated with a risk of bleeding and malignant transformation, particularly the inflammatory (also known as telangiectatic) and β-catenin mutated subtypes. Accurate diagnosis needs to be obtained to select patients eligible for surgical resection. MRI has markedly improved diagnosis and can identify the major hepatocellular adenomas subtypes. The use of biopsy results to inform the indication for resection remains questionable. However, when diagnosis remains uncertain after imaging, percutaneous biopsy could help improve diagnostic accuracy.
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Affiliation(s)
- Jacques Belghiti
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Paradis
- Department of Pathology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
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Kang T, Kim S, Jang K, Choi D, Choi J, Park C. Inflammatory myofibroblastic tumours of the liver: Gadoxetic acid-enhanced and diffusion-weighted MRI findings with 18F-FDG PET/CT and clinical significance of regression on follow-up. Clin Radiol 2014; 69:509-18. [DOI: 10.1016/j.crad.2013.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/24/2013] [Accepted: 12/30/2013] [Indexed: 01/17/2023]
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Groenveld RL, Raber MH, Oosterhof-Berktas R, Eijken E, Klaase JM. Abdominal inflammatory myofibroblastic tumor. Case Rep Gastroenterol 2014; 8:67-71. [PMID: 24707245 PMCID: PMC3975205 DOI: 10.1159/000360843] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A 28-year-old woman was referred to our hospital because of abdominal pain, weight loss and a palpable intra-abdominal mass. A CT scan revealed a tumor with a diameter of 7 cm with sharp margins, intra-tumoral fatty components and enhancing soft tissue. After initial workup, which suggested an inflammatory myofibroblastic tumor (IMT), she underwent laparotomy with complete resection. Pathological examination indeed revealed IMT. IMT is a rare benign neoplasm and has been described in nearly the entire body. It presents with nonspecific symptoms. The therapy of abdominal IMT consists of radical surgery because of high local recurrence rates. In this case report clinical, surgical, radiological and histological features with a review of the relevant literature are described.
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Affiliation(s)
| | - Menno H Raber
- Department of Surgery, Laboratorium Pathologie Oost Nederland, Hengelo, The Netherlands
| | - Richard Oosterhof-Berktas
- Department of Radiology of Medisch Spectrum Twente, Enschede, Laboratorium Pathologie Oost Nederland, Hengelo, The Netherlands
| | - Erik Eijken
- Department of Pathology, Laboratorium Pathologie Oost Nederland, Hengelo, The Netherlands
| | - Joost M Klaase
- Department of Surgery, Laboratorium Pathologie Oost Nederland, Hengelo, The Netherlands
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20
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Elpek GÖ. Inflammatory Myofibroblastic Tumor of the Liver: A Diagnostic Challenge. J Clin Transl Hepatol 2014; 2:53-7. [PMID: 26356188 PMCID: PMC4521256 DOI: 10.14218/jcth.2013.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 02/07/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is an uncommon myofibroblastic neoplasm that was formerly included within the broad category of inflammatory pseudotumor (IPT). IMT is rarely encountered in the liver. Similar to IMT of other organs, the interchangeable use of the terms IMT and IPT in liver has made the analysis of these lesions difficult. In this review, clinical and pathological features of IMT of the liver are reviewed and the differential diagnosis of IMT is discussed, with emphasis on IPT and the other entities included in this large category. IMT can mimic malignant tumors. There are no known unique diagnostic clinical, laboratory, or radiological features. The definitive diagnosis of IMT depends on careful pathological examination. The histopathological evaluation of hepatic IMT reveals that, the myxoid/vascular pattern is the most frequently observed, followed by, in decreasing frequency, fibrous histiocytoma-like pattern and hypocellular fibrous pattern. In IMT of the liver, anaplastic lymphoma kinase (ALK) expression reliably predicts the presence of an ALK gene rearrangement. The diagnosis of hepatic IMT depends on the dominant histopathological pattern, and the management of the disease is still controversial. IMT of the liver is a distinctive neoplasm of intermediate biological potential, and should be distinguished from the variety of lesions that are included under the broad category of IPT. Therefore, to avoid confusion regarding the true incidence and behavior of hepatic IMT, the term IPT should not be used interchangeably with IMT. The rarity of IMT in liver should not minimize its consideration in the differential diagnosis of liver tumors, especially in patients with tumor markers in normal range.
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Affiliation(s)
- Gülsüm Özlem Elpek
- Department of Pathology, Akdeniz University Medical School, Antalya, Turkey
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21
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22
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Affiliation(s)
- Osama Naga
- University Medical Center of El Paso, TX 79905, USA.
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23
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Katoh M, Imamura H, Yoshino M, Aoki T, Abumiya T, Aida T. Spontaneous regression of an anterior skull base mass. J Clin Neurosci 2010; 17:786-8. [PMID: 20356749 DOI: 10.1016/j.jocn.2009.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 10/04/2009] [Indexed: 11/29/2022]
Abstract
Spontaneous regression of an intracranial mass is rare. We report a 77-year-old man with spontaneous regression of an anterior skull base mass suspected to be an inflammatory pseudotumor. The patient attended our outpatient department approximately once per month for a regular check-up following a brain stem infarction. A small mass was detected at the anterior skull base by MRI. The mass gradually grew to about 3 cm over a period of 5 years and then remained stable for 3 years. Thereafter, the mass showed spontaneous regression 8 years after it was first visible on MRI. 'Inflammatory pseudotumor' is a broad category and the natural history of these lesions is highly variable. Although the definition does include some types of malignant lesion, most masses are benign lesions that can regress spontaneously, as in our patient. A 'wait-and-see' policy is appropriate for such patients.
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Affiliation(s)
- Masahito Katoh
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Kita 22, Nishi 15, Chuou-ku, Sapporo 060-0022, Japan.
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Li JY, Yong TY, Coleman M, Astill D, Passaris G, Juneja R, Siddins M, Barbara JAJ. Bilateral renal inflammatory pseudotumour effectively treated with corticosteroid. Clin Exp Nephrol 2009; 14:190-8. [PMID: 19921350 DOI: 10.1007/s10157-009-0242-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 10/08/2009] [Indexed: 01/20/2023]
Abstract
Inflammatory pseudotumour (IPT) is a rare disease of unknown cause that most commonly involves the lung but can occur in almost any site in the body. Occurrence in the kidneys is very rare and bilateral renal involvement even rarer. There are 34 previously reported cases in the English-language medical literature between 1966 and 2008. Herein we report a case of IPT infiltrating both kidneys. We have also reviewed the clinical features, radiological findings, treatment and outcome of renal IPT. Clinical features at presentation are commonly non-specific. Features on imaging are inadequate to make a diagnosis of IPT or to clearly distinguish it from malignancy. Consequently diagnosis has frequently been made after nephrectomy and on a few occasions with the aid of percutaneous or open biopsies. The majority of renal IPT (83%) have been treated with nephrectomy and those cases with bilateral IPT have received corticosteroids.
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Affiliation(s)
- Jordan Yuanzhi Li
- Department of Nephrology, Flinders Medical Centre, Flinders University, Bedford Park, Adelaide, SA 5042, Australia.
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25
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Inflammatory pseudotumours of the liver: a spectrum of presentation and management options. Eur J Surg Oncol 2009; 35:1295-8. [PMID: 19515527 DOI: 10.1016/j.ejso.2009.04.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Revised: 03/23/2009] [Accepted: 04/02/2009] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To review the current management options in inflammatory pseudotumours via analysis of ten cases from this unit the largest experience of this pathology in a Western series. To assess the medical and operative options available for this condition and the varying outcomes and the lessons learned in this unit over the time period. RESULTS Data from the ten cases were analysed and a comprehensive review of the published literature to date has detailed 128 case reports with 215 cases of inflammatory pseudotumour of the liver. Data analysed included patient demographics, diagnostic modalities, details of treatment and eventual outcome. The data was tabulated using an Excel spreadsheet (Microsoft Excel 2004 for Mac 2004.Version 11.0). Categorical variables were compared using Pearson's chi(2) test and p values <0.05 were defined as statistically significant. Statistical analysis was performed using SPSS for Windows (Version 9.0, SPSS Inc., Chicago, IL). CONCLUSION Emphasis is placed on a preferred medical management initially for this tumour with a good prognosis coupled with regular follow up. There may be a need for surgical resection cases where diagnosis is unclear or the patient is not responding to medical treatment with progression of disease or symptoms.
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26
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Peddu P, Huang D, Kane PA, Karani JB, Knisely AS. Vanishing liver tumours. Clin Radiol 2007; 63:329-39. [PMID: 18275874 DOI: 10.1016/j.crad.2007.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 08/28/2007] [Accepted: 08/31/2007] [Indexed: 02/01/2023]
Abstract
Spontaneous resolution of liver tumours is a rare, but recognized entity that has been reported to occur within the spectrum of benign and malignant liver tumours occurring in both adult and paediatric population. The aetiology of this unusual phenomenon is not clearly understood. In this article we present case examples of various benign and malignant liver tumours that have regressed spontaneously without treatment together with a review of the literature, and a summary of the current understanding of the pathogenesis of these tumours.
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Affiliation(s)
- P Peddu
- Department of Radiology, King's College Hospital, London, UK.
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27
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Díaz-Torné C, Narváez J, De Lama E, Diez-García M, Narváez JA, Bernad B, Llatjos R, Nolla JM, Valverde J. Inflammatory pseudotumor of the liver associated with rheumatoid arthritis. ACTA ACUST UNITED AC 2007; 57:1102-6. [PMID: 17665472 DOI: 10.1002/art.22904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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28
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Akatsu T, Wakabayashi G, Tanimoto A, Kameyama K, Kitajima M. Inflammatory pseudotumor of the liver masquerading as hepatocellular carcinoma after a hepatitis B virus infection: Report of a case. Surg Today 2007; 36:1028-31. [PMID: 17072730 DOI: 10.1007/s00595-006-3306-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Accepted: 05/24/2006] [Indexed: 12/21/2022]
Abstract
We report a rare case of hepatic inflammatory pseudotumor (IPT) after a hepatitis B virus (HBV) infection. Early contrast enhancement on computed tomography (CT) with a washout phenomenon at the delayed phase, and depleted Kupffer cell function on superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) suggested hepatocellular carcinoma (HCC). However, the lack of a tumor capsule, absence of liver cirrhosis, and normal serum levels of alpha-fetoprotein and PIVKA-II (protein induced by vitamin K absence; descarboxyprothrombin) contradicted this diagnosis. We excised the tumor to exclude malignancy, and the histopathological diagnosis was IPT. Recent evidence suggests that this entity has changed from an extremely rare pathology to an established disease. Thus, IPT should be considered in the differential diagnosis of a liver mass with an infectious-inflammatory antecedent. Although surgery is not mandatory, surgical removal is recommended if there is a possibility of malignancy. Further investigations are warranted to elucidate the mechanisms of IPT developing after an HBV infection.
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Affiliation(s)
- Tomotaka Akatsu
- Departments of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan
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29
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Lee SJ. Rapid Spontaneous Regression of Bilateral Pseudotumor. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2007. [DOI: 10.3341/jkos.2007.48.8.1151-1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seung Jun Lee
- Department of Ophthalmology, Gangwon National University, College of Medicine, Gangwon, Korea
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30
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Cherki S, Cotte E, Boibieux A, Baulieux J, Adham M. [Hepatic tuberculosis: case report of pseudotumoral form]. ACTA ACUST UNITED AC 2006; 30:1317-20. [PMID: 17185977 DOI: 10.1016/s0399-8320(06)73543-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Inflammatory pseudo-tumors of the liver are rare and difficult to diagnose, mimicking malignant tumors. We report a patient, 42 year old with hepatic pseudo-tumor who was suspected to have pseudotumoral hepatic tuberculosis without immunodepression and treated by major hepatic surgery because no sure diagnosis. Therapeutic approach of hepatic inflammatory pseudotumors is often medical and surgical and may need major hepatic surgery in case of sure etiologic diagnosis.
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Affiliation(s)
- Stéphane Cherki
- Service de Chirurgie Générale et Digestive et de la Transplantation Hépatique, Hôpital de la Croix-Rousse
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31
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Leon CJ, Castillo J, Mebold J, Cortez L, Felmer R. Inflammatory myofibroblastic tumor of the stomach: an unusual complication after gastrectomy. Gastrointest Endosc 2006; 63:347-9. [PMID: 16427957 DOI: 10.1016/j.gie.2005.09.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2005] [Accepted: 09/10/2005] [Indexed: 01/06/2023]
Affiliation(s)
- Carlos J Leon
- Department of Surgery, Surgical Endoscopy Unit, Barros Luco Trudeau Hospital, University of Chile, Santiago, Chile
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32
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Dasgupta D, Guthrie A, McClean P, Davison S, Luntley J, Rajwal S, Lodge JPA, Prasad KR, Wyatt JI, Stringer MD. Liver transplantation for a hilar inflammatory myofibroblastic tumor. Pediatr Transplant 2004; 8:517-21. [PMID: 15367291 DOI: 10.1111/j.1399-3046.2004.00206.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 7-yr-old boy presented with obstructive jaundice secondary to an inflammatory myofibroblastic tumor centered on the hepatic hilum and extending into the liver. The tumor was further complicated by portal vein phlebitis and occlusion. Attempted resection of the tumor with portal vein reconstruction and bilioenteric drainage was unsuccessful and he required urgent orthotopic liver transplantation. In contrast to more peripheral inflammatory myofibroblastic tumors in the liver, hilar lesions are locally aggressive, causing occlusive portal phlebitis and biliary obstruction. Successful management may include the need for liver transplantation.
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Affiliation(s)
- D Dasgupta
- Children's Liver and GI Unit, Gledhow Wing, St James's University Hospital, Leeds LS9 7TF, UK
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33
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Fritzsch J, Richter M, Edelmann C, Lange R, Tannapfel A. [35-year old male with fever and round mass of the liver]. Internist (Berl) 2004; 45:713-6. [PMID: 15133612 DOI: 10.1007/s00108-004-1195-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 35 year old male suffered from fever till 39 degrees C and malaise since 6 months; infectious or neoplastic causes have been ruled out. Ultrasonography revealed a hypoechoic lesion of 75 mm diameter in the liver. The histologic examination of the needle biopsy showed an inflammatory process, and the final diagnosis was inflammatory pseudotumor. EBV specific LMP-1 protein was detected within the tumor immunohistochemically. A liver segment resection was performed, and the patient has been well and without fever since then for 18 months. Inflammatory pseudotumor is a rare but important differential diagnosis in cases of hypoechoic liver lesions associated by fever, if there is no abscess or malignancy. The diagnosis must be confirmed histologically, because imaging techniques cannot reliably classify the lesion.
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Affiliation(s)
- J Fritzsch
- Abteilung für Innere Medizin, HELIOS Klinik Zwenkau.
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Abstract
Inflammatory pseudotumor is a quasineoplastic lesion that most commonly involves the lung and the orbit, but it has been reported to occur in nearly every site in the body. The pathogenesis, natural history, clinical presentation, imaging findings, and treatment options for inflammatory pseudotumor in the lung, heart, gastrointestinal tract, adrenal gland, iliopsoas muscle, orbit, and central nervous system are discussed. Because inflammatory pseudotumors mimic malignant tumors both clinically and radiologically, the radiologist should be familiar with this entity and help avoid unnecessary radical surgery when possible.
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Affiliation(s)
- Lakshmana Das Narla
- Department of Radiology, Medical College of Virginia VCU Health System, Main Hospital 3rd Fl, 1250 E Marshall St, Richmond, VA 23298, USA.
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