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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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Filips A, Maurer MH, Montani M, Beldi G, Lachenmayer A. Inflammatory myofibroblastic tumor of the liver: A case report and review of literature. World J Hepatol 2020; 12:170-183. [PMID: 32685109 PMCID: PMC7336290 DOI: 10.4254/wjh.v12.i4.170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumors of the liver (IMTL) are extremely rare neoplasms and very little is known about their clinical presentation, pathogenesis, and biological behavior. Due to their absolute rarity, it is almost impossible to obtain a definite diagnosis without histological examination. Because of their intermediate biological behavior with the risk for local recurrence and metastases, surgical resection is recommend whenever IMTL is suspect.
CASE SUMMARY We herein present a case of an otherwise healthy 32-year-old woman who presented with intermittent fever, unclear anemia, malaise and right flank pain 4 mo postpartum. The liver mass in segment IVa/b was highly FDG avid in the positron emission tomography-computed tomography. Hepatic resection was performed achieving a negative resection margin and an immediate resolution of all clinical symptoms. Histological analysis diagnosed the rare finding of an inflammatory myofibroblastic tumor of the liver and revealed cytoplasmic anaplastic lymphoma kinase expression by immunohistochemistry. Twelve months follow-up magnetic resonance imaging showed no recurrence and no metastases in the fully recovered patient.
CONCLUSION IMTLs are extremely rare and difficult to diagnose. Due to their intermediate biological behavior, surgical resection should be perform whenever feasible and patients should be followed-up in order to detect recurrence and metastasis as early as possible.
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Affiliation(s)
- Alexandra Filips
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Martin H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Matteo Montani
- Institute of Pathology, Inselspital, University Hospital, University Bern, Bern 3010, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
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Pediatric Inflammatory Myofibroblastic Tumor of the Liver: A Rare Cause of Portal Hypertension. ACG Case Rep J 2019; 6:1-4. [PMID: 31620493 PMCID: PMC6658019 DOI: 10.14309/crj.0000000000000028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022] Open
Abstract
Hepatic inflammatory pseudotumors or myofibroblastic tumors are benign neoplasms rarely seen in children. We report a case of a previously healthy 10-year-old girl with prolonged fever and abdominal pain who was found to have hepatosplenomegaly and pancytopenia. Imaging revealed a periportal mass along with thrombosis of portal vein and splenomegaly. Liver biopsy showed normal hepatic architecture with no evidence of cirrhosis. She underwent endoscopic banding of esophageal varices. Biopsy of the mass was suggestive of inflammatory myofibroblastic tumor without malignant changes. She has been successfully managed with nonsteroidal anti-inflammatory drug and pulse steroids with resolution of symptoms and decrease in size of the tumor with more than 2 years of follow-up.
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Yin L, Zhu B, Lu XY, Lau WY, Zhang YJ. Misdiagnosing hepatic inflammatory pseudotumor as hepatocellular carcinoma: A case report. JGH OPEN 2018; 1:76-78. [PMID: 30483539 PMCID: PMC6207033 DOI: 10.1002/jgh3.12012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022]
Abstract
A 61‐year‐old Chinese male was found to have a lesion in the left liver during a routine body check‐up. Laboratory tests revealed no abnormalities except for a rise in C‐reactive protein. Computed tomography showed features suggestive of hepatocellular carcinoma. The patient underwent liver IVb segmentectomy and cholecystectomy. Histopathology showed features of hepatic inflammatory pseudotumor. The C‐reactive protein decreased to close to normal on postoperative day 9. A patient with hepatic inflammatory pseudotumor who presented with features mimicking hepatocellular carcinoma was reported. A preoperatively raised C‐reactive protein was the only hint which suggested that our patient might have had hepatic inflammatory pseudotumor instead of hepatocellular carcinoma.
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Affiliation(s)
- Lei Yin
- Second Department of Biliary Surgery Eastern Hepatobiliary Surgery Hospital Shanghai China
| | - Bin Zhu
- Second Department of Biliary Surgery Eastern Hepatobiliary Surgery Hospital Shanghai China
| | - Xin-Yuan Lu
- Department of Pathology Eastern Hepatobiliary Surgery Hospital Shanghai China
| | - Wan Yee Lau
- Second Department of Biliary Surgery Eastern Hepatobiliary Surgery Hospital Shanghai China.,Faculty of Medicine, The Chinese University of Hong Kong Prince of Wales Hospital Shatin Hong Kong SAR
| | - Yong Jie Zhang
- Second Department of Biliary Surgery Eastern Hepatobiliary Surgery Hospital Shanghai China
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Dalton BGA, Thomas PG, Sharp NE, Manalang MA, Fisher JE, Moir CR, St Peter SD, Iqbal CW. Inflammatory myofibroblastic tumors in children. J Pediatr Surg 2016; 51:541-4. [PMID: 26732283 DOI: 10.1016/j.jpedsurg.2015.11.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMFT) is an uncommon neoplasm in children. METHODS Retrospective review from 1993 to 2014 of patients ≤18years of age with a histopathologic diagnosis of IMFT treated at two tertiary centers. RESULTS Thirty-two patients were diagnosed with IMFT. Mean (±SD) age was 9.3±5.7years at diagnosis. Tumor location was variable: abdomen/pelvis (28%), head/neck region (22%), intrathoracic (22%), genitourinary (9%), bowel (6%) liver (6%), and musculoskeletal (6%). Median follow-up was 2.6±4.6years, with 3 recurrences and 2 deaths, which occurred only after recurrence. Positive microscopic margin after resection was associated with recurrence, compared to those that had a negative margin (40% vs. 0%, p=0.04). Recurrence was associated with increased mortality (67% vs 0%, p=0.01). Time from first symptoms to resection was shorter in those with recurrence (25.8±22 vs. 179±275days, p=0.01) and in nonsurvivors (44.0±8.0 vs. 194.3±53.4days, p=0.02). Adjuvant chemotherapy, not including steroid monotherapy, either given before or after resection, was administered more often to nonsurvivors (100% vs 4%, p=0.009), and use of corticosteroids was also higher in the nonsurvivors (100% vs. 15%, p=0.04). CONCLUSIONS IMFT is a rare pediatric neoplasm with variable locations. Complete excision is critical for cure. Proposed guidelines for diagnosis, treatment and surveillance of theses tumors in children are reported.
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Affiliation(s)
| | | | - Nicole E Sharp
- Children's Mercy Hospital, Kansas City, MO, United States
| | | | - James E Fisher
- Mayo Clinic Division of Pediatric Surgery, Rochester, MN, United States
| | | | | | - Corey W Iqbal
- Children's Mercy Hospital, Kansas City, MO, United States.
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Abstract
Inflammatory myofibroblastic tumor (IMT) is an uncommon lesion with variable clinical behaviors from benign to mimicking malignant tumors. On rare occasions, IMT may exhibit malignant transformation, and the strategy of malignant IMT is remained undetermined. Herein, we report an extremely unusual case of IMT with malignant transformation of the urinary bladder in a 14-year-old boy characterized by local aggressive behavior and was successfully treated by combined surgery and perioperative chemotherapy.
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Al-Hussaini H, Azouz H, Abu-Zaid A. Hepatic inflammatory pseudotumor presenting in an 8-year-old boy: A case report and review of literature. World J Gastroenterol 2015; 21:8730-8738. [PMID: 26229415 PMCID: PMC4515854 DOI: 10.3748/wjg.v21.i28.8730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/27/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatic inflammatory pseudotumors are uncommon benign lesions. Accurately diagnosing hepatic inflammatory pseudotumor can be very challenging because the clinical presentation and radiological appearances are nonspecific and cannot be certainly distinguished from malignant neoplastic processes. Herein, we present a case of hepatic IPT in an 8-year-old boy who presented to clinic with a 3-mo history of a tender hepatic mass, fever of unknown origin, and 9-kg weight loss. The physical examination was notable for tender hepatomegaly. Laboratory investigations were notable for a normal hepatic profile and elevated erythrocyte sedimentation rate and C-reactive protein. A T2-attenuated magnetic resonance imaging scan of the abdomen showed a 4.7 cm × 4.7 cm × 6.6 cm, contrast-enhancing, hyper-intense, well-defined lesion involving the right hepatic lobe. In view of the unremitting symptoms, tender hepatomegaly, thrombosed right hepatic vein, nonspecific radiological findings, and high suspicion of a deep-seated underlying infection or malignancy, a right hepatic lobectomy was recommended. Microscopically, the hepatic lesion exhibited a mixture of inflammatory cells (histiocytes, plasma cells, mature lymphocytes, and occasional multinucleated giant cells) in a background of dense fibrous tissue. Immunohistochemically, the cells stained negative for SMA, ALK-1, CD-21 and CD-23, diffusely positive for CD-68, and focally positive for IgG4. The final histopathological diagnosis was consistent with hepatic IPT. At the postoperative 4-mo follow-up, the patient was asymptomatic without radiological evidence of recurrence.
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Çakır M, Tüzün S, Savaş A, Tosyalı Y. Two pseudotumor cases mimicking liver malignancy. Turk J Surg 2015; 33:212-216. [PMID: 28944337 DOI: 10.5152/ucd.2015.2912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/12/2015] [Indexed: 12/19/2022]
Abstract
Inflammatory pseudotumor of the liver is a rare benign tumor that can be confused with malignant tumors of the liver. It is usually diagnosed after pathologic evaluation of the resected lesion. If a mass lesion in the liver is suspicious for malignancy on radiologic evaluation then surgical resection is planned for suitable patients rather than a biopsy. Inflammatory pseudotumors are similar to malignant tumors on macroscopic assessment, but microscopically they are characterized by the presence of inflammatory cells. In case of clinical or radiologic suspicion, the lesion is biopsied and once the diagnosis of inflammatory pseudotumor is made the lesion is managed by conservative-medical treatment. It must be kept in mind as part of differential diagnosis to avoid unnecessary surgery.
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Affiliation(s)
- Mikail Çakır
- Clinic of General Surgery, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Sefa Tüzün
- Clinic of General Surgery, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Anıl Savaş
- Clinic of General Surgery, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Yılmaz Tosyalı
- Clinic of Pathology, Haseki Training and Research Hospital, İstanbul, Turkey
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Yang X, Zhu J, Biskup E, Cai F, Li A. Inflammatory pseudotumors of the liver: experience of 114 cases. Tumour Biol 2015; 36:5143-8. [PMID: 25663462 DOI: 10.1007/s13277-015-3167-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/26/2015] [Indexed: 01/01/2023] Open
Abstract
Hepatic inflammatory pseudotumors (HIPT) are rare benign neoplasms with unknown etiology and a great potential for mimicry, challenging diagnostics, and treatment features. The aim of the study was to retrospectively analyze the imaging, pathological, and clinical features of HIPT in our large cohort of patients in order to increase the understanding and suggest a scoring system for treatment approaches. Retrospective study analyzed 114 HIPT cases recorded from July 2006 to July 2012, when surgery was performed. Data were compared with chi-square test. In our study population, the mean age was 53.14 ± 10.98 years, with 69 male and 45 female patients. Most presented symptoms were abdominal pain (59/144, 41.0 %), fever (48/114, 42.1 %), abdominal distension (35/144, 24.3 %), and weight loss (12/144, 8.3 %). Laboratory examinations were normal. Sixteen cases were HBsAg positive and 8 had liver cirrhosis. Most of the tumors were located in the right lobe (79/114, 69.3 %), 33 in the left lobe, and 2 in the caudal lobe. Three imaging modalities, such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), were compared and showed significant differences in sensitivity and sensibility. HIPT diagnostics are challenging, and conservative treatment should be prioritized as soon as the diagnosis is made. CT and MRI seem to have comparable diagnostic sensitivity. We propose a guideline for consideration of operative approach.
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Affiliation(s)
- Xiaoyu Yang
- Division of Special Treatment II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China,
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10
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Zhao JJ, Ling JQ, Fang Y, Gao XD, Shu P, Shen KT, Qin J, Sun YH, Qin XY. Intra-abdominal inflammatory myofibroblastic tumor: Spontaneous regression. World J Gastroenterol 2014; 20:13625-13631. [PMID: 25309095 PMCID: PMC4188916 DOI: 10.3748/wjg.v20.i37.13625] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/01/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammatory myofibroblastic tumors are usually treated by surgical resection. We herein report two cases of intra-abdominal inflammatory myofibroblastic tumors that were unresectable and underwent spontaneous regression without any treatment. Our case report and literature review show that regression is more common in the middle-aged and older male populations. Abdominal discomfort and fever were the most common symptoms, but the majority of patients had no obvious physical signs. There was no specific indicator for diagnosis. The majority of the lesions regressed within 3 mo and nearly all of the masses completely resolved within 1 year. We conclude that the clinical characteristics of inflammatory myofibroblastic tumors are variable and, accordingly, the disease needs to be subdivided and treated on an individual basis. Surgery is always the first-line treatment; however, for those masses assessed as unresectable, conservative therapy with intense follow-up should be considered.
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Inflammatory myofibroblastic tumor of the gallbladder: imaging aspects. J Med Ultrason (2001) 2014; 42:89-95. [DOI: 10.1007/s10396-014-0566-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/01/2014] [Indexed: 12/12/2022]
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Matsuo Y, Sato M, Shibata T, Morimoto M, Tsuboi K, Shamoto T, Hirokawa T, Sato T, Takahashi H, Takeyama H. Inflammatory pseudotumor of the liver diagnosed as metastatic liver tumor in a patient with a gastrointestinal stromal tumor of the rectum: report of a case. World J Surg Oncol 2014; 12:140. [PMID: 24886578 PMCID: PMC4016664 DOI: 10.1186/1477-7819-12-140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/27/2014] [Indexed: 01/14/2023] Open
Abstract
Background Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion. A case of IPT of the liver found in association with a malignant gastrointestinal stromal tumor (GIST) is reported. Case report A 74-year-old man was admitted to our hospital for a liver tumor. He previously underwent rectal amputation for a malignant GIST. Computed tomography (CT) revealed a low-density area in the liver and dynamic contrast-enhanced MRI (EOB-MRI) showed that the tumor was completely washed out in the delayed phase. 18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) showed strong uptake in the liver. A diagnosis of liver metastasis was made and partial hepatectomy was performed. Microscopic examination showed that the tumor was an IPT. Conclusion Differential diagnosis between IPT and malignant neoplasms is difficult. Moreover, FDG-PET revealed strong uptake in the tumor. To our knowledge, this is the first patient reported to have an IPT in association with a rectal GIST. This patient is discussed along with a review of the literature.
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Affiliation(s)
- Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan.
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Yoshiya S, Ikegami T, Yoshizumi T, Wang H, Harada N, Yamashita YI, Nishie A, Shirabe K, Oda Y, Maehara Y. Fairly rare de novo inflammatory pseudotumor in a graft after living donor liver transplantation. Liver Transpl 2014; 20:616-8. [PMID: 24458763 DOI: 10.1002/lt.23828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/17/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Shohei Yoshiya
- Departments of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Wong JS, Tan YM, Chung A, Lim KH, Thng CH, Ooi LL. Inflammatory Pseudotumour of the Liver Mimicking Cholangiocarcinoma. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n6p304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
| | - Yu Meng Tan
- FeM Surgery, Mount Elizabeth Medical Centre, Singapore
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Kye BH, Kim HJ, Kang SG, Yoo C, Cho HM. A case of inflammatory myofibroblastic tumor originated from the greater omentum in young adult. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:380-4. [PMID: 22708101 PMCID: PMC3373989 DOI: 10.4174/jkss.2012.82.6.380] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 12/05/2011] [Accepted: 12/12/2011] [Indexed: 01/21/2023]
Abstract
Inflammatory myofibroblastic (IMF) tumor is a rare solid tumor that often affects children. IMF tumors occur primarily in the lung, but the tumor may affect any organ system with protean manifestations. A 22-year-old woman was evaluated for palpable low abdominal mass that had been increasing in size since two months prior. Abdominal computed tomography showed a lobulated, heterogeneous contrast enhancing soft tissue mass, 6.5 × 5.7 cm in size in the ileal mesentery. At surgery, the mass originated from the greater omentum laying in the pelvic cavity and was completely excised without tumor spillage. Histologically, the mass was a spindle cell lesion with severe atypism and some mitosis. Immunohistochemistry for anaplastic lymphoma kinase-1 revealed that the lesion was an IMF tumor. Because of its local invasiveness and its tendency to recur, this tumor can be confused with a soft tissue sarcoma. Increasing physician awareness of this entity should facilitate recognition of its clinical characteristics and laboratory findings.
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Affiliation(s)
- Bong Hyeon Kye
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
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16
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Inflammatory pseudotumor of the liver and spleen. Clin J Gastroenterol 2011; 4:233-235. [DOI: 10.1007/s12328-011-0224-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/31/2011] [Indexed: 12/12/2022]
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Ntinas A, Kardassis D, Miliaras D, Tsinoglou K, Dimitriades A, Vrochides D. Inflammatory pseudotumor of the liver: a case report and review of the literature. J Med Case Rep 2011; 5:196. [PMID: 21600001 PMCID: PMC3123642 DOI: 10.1186/1752-1947-5-196] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 05/21/2011] [Indexed: 12/18/2022] Open
Abstract
Introduction Inflammatory pseudotumor of the liver represents a fairly uncommon pathology. Although it is a benign tumor, the correct diagnosis can be missed. Case presentation We report the case of a 55-year-old Caucasian man, who presented with a one-month history of abdominal pain and weight loss. He was diagnosed with a primary liver tumor by computed tomography and magnetic resonance imaging. Alpha-fetoprotein levels ranged within normal limits. A right posterior sectorectomy was performed. Histopathology revealed an inflammatory pseudotumor of the liver. Our patient remains in good condition one year later. Conclusion Although inflammatory pseudotumor of the liver is usually a benign process, controversy regarding its management still exists. With this case report we review the existing literature and consider hepatectomy as a safe treatment approach.
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Affiliation(s)
- Achilleas Ntinas
- Department of Hepato-Pancreato-Biliary Surgery, Euromedica General Clinic, 2 Gravias - 11 Maria Callas Str, 546 45, Thessaloniki, Greece.
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18
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Sacco O, Gambini C, Gardella C, Tomà P, Rossi UG, Jasonni V, Bush A, Rossi GA. "Atypical steroid response" in a pulmonary inflammatory myofibroblastic tumor. Pediatr Pulmonol 2010; 45:721-6. [PMID: 20575096 DOI: 10.1002/ppul.21237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 6-year-old girl was evaluated for the presence of a paratracheal mass with right upper lobe atelectasis due to an endobronchial mass. Bronchoscopic biopsy established a diagnosis of inflammatory myofibroblastic tumor (IMT) and prednisone initially led to a significant reduction of the endobronchial lesion. However, 8 weeks later, when still on prednisone, the mediastinal mass enlarged dramatically. At thoracotomy, a well-circumscribed, multilobulated mass was partially resected and a diagnosis of IMT confirmed. Immunosuppression by corticosteroids may have favored the rapid progression of this apparently benign, indolent tumor.
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Ashcroft MW, Ng CS, Frost RA, Freeman AH. Biliary inflammatory pseudotumour: report of two cases and review of the literature. Clin Radiol 2009; 64:449-55. [PMID: 19264191 DOI: 10.1016/j.crad.2008.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 11/17/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
Affiliation(s)
- M W Ashcroft
- Department of Radiology, Salisbury District Hospital, Wiltshire, UK
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21
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Chen HW, Lai EC, Huang XJ, Chen FN, Lu RL, Pan AZ, Lau WY. Inflammatory Myofibroblastic Tumours of the Spleen and Liver. Asian J Surg 2008; 31:25-8. [DOI: 10.1016/s1015-9584(08)60051-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kai K, Matsuyama S, Ohtsuka T, Kitahara K, Mori D, Miyazaki K. Multiple inflammatory pseudotumor of the liver, mimicking cholangiocarcinoma with tumor embolus in the hepatic vein: report of a case. Surg Today 2007; 37:530-3. [PMID: 17522778 DOI: 10.1007/s00595-006-3434-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 12/02/2006] [Indexed: 02/08/2023]
Abstract
A 68-year-old Japanese woman complaining of general fatigue and intermittent high fever was admitted to our hospital. Abdominal ultrasonography showed two tumors in the lateral segment of the liver, with soft tissue in the left hepatic vein that was considered to be a tumor embolus. A diagnosis of cholangiocarcinoma was made based on various radiological and laboratory examinations and therefore a surgical resection was performed. Microscopically, the tumor consisted of inflammatory cells, which had aggressively invaded the hepatic vein and Arantius' duct. The pathological diagnosis was inflammatory pseudotumor (IPT) that had invaded the hepatic vein. Although many cases of hepatic IPT have been previously reported, cases of hepatic IPT massively invading the hepatic vein are very rare as far as we could determine, based on a literature search. We herein report this case and discuss the diagnosis and treatment regarding hepatic IPT with massive venous invasion.
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Affiliation(s)
- Keita Kai
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan
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Hoosein MM, Tapuria N, Standish RA, Koti RS, Webster GJM, Millar AD, Davidson BR. Inflammatory pseudotumour of the liver: the residuum of a biliary cystadenoma? Eur J Gastroenterol Hepatol 2007; 19:333-6. [PMID: 17353699 DOI: 10.1097/meg.0b013e328010b128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Inflammatory pseudotumour is a rare form of a liver mass. We report the case of a 28-year-old man presenting with obstructive jaundice, in whom an inflammatory pseudotumour arose with the resolution of a mucus secreting cystic liver lesion. The initial features suggested an intrahepatic cystadenoma or cystadenocarcinoma, which on its involution left a solid mass. Histopathology showed an inflammatory pseudotumour with no evidence of malignancy. A similar case has been reported recently, with the development of an inflammatory pseudotumour following collapse of a liver cyst seen on imaging. These two cases may shed some light on the origins of these rare liver lesions.
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Affiliation(s)
- Moinuddin M Hoosein
- University Department of Surgery, Royal Free and University College Medical School, Royal Free Hospital, London, UK
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24
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Kim YW, Lee JG, Kim KS, Yoon DS, Lee WJ, Kim BR, Shin EA, Park YN, Choi JS. Inflammatory pseudotumor of the liver treated by hepatic resection: a case report. Yonsei Med J 2006; 47:140-3. [PMID: 16502497 PMCID: PMC2687572 DOI: 10.3349/ymj.2006.47.1.140] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Inflammatory pseudotumor (IPT) of the liver is rare benign tumor. When the diagnosis of IPT is established with biopsy, simple observation or conservative therapy is preferred because of the possibility of regression. But IPT is unresponsive to the conservative treatment, surgical resection should be considered. We experienced a 63-year-old male, who was suspected hepatocellular carcinoma in abdominal computed tomography (CT) and magnetic resonance image (MRI) scan, presented with 2-month history of intermittent fever and weight loss. Percutaneous ultrasound guided core biopsy confirmed IPT of the liver. Non-steroidal anti-inflammatory drugs and antibiotics were administered for 8 and 4 weeks, respectively, but fever continued. So, extended right hepatectomy was performed for IPT of the liver and then fever subsided. The patient remains well during a follow-up period of 12 months.
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Affiliation(s)
- Young Wan Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Sub Yoon
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jung Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ro Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ah Shin
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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25
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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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26
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Hagenstad CT, Kilpatrick SE, Pettenati MJ, Savage PD. Inflammatory myofibroblastic tumor with bone marrow involvement. A case report and review of the literature. Arch Pathol Lab Med 2003; 127:865-7. [PMID: 12823044 DOI: 10.5858/2003-127-865-imtwbm] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Inflammatory myofibroblastic tumor, also referred to as inflammatory fibrosarcoma, is a rare tumor composed of myofibroblastic spindle cells of uncertain etiology and disputed nosology. We report a case of inflammatory myofibroblastic tumor of the omentum with involvement of the bone marrow in an 18-year-old man. Histologic and immunohistochemical studies of the abdominal mass and bone marrow were consistent with inflammatory myofibroblastic tumor. Additionally, fluorescence in situ hybridization using a probe specific for the ALK gene showed disruption of the gene. The literature is reviewed with emphasis on the ability of inflammatory myofibroblastic tumor to recur, metastasize, and cause mortality.
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Affiliation(s)
- Christopher T Hagenstad
- Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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27
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Venkataraman S, Semelka RC, Braga L, Danet IM, Woosley JT. Inflammatory myofibroblastic tumor of the hepatobiliary system: report of MR imaging appearance in four patients. Radiology 2003; 227:758-63. [PMID: 12728186 DOI: 10.1148/radiol.2273020572] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of this report is to describe the magnetic resonance (MR) imaging features of hepatic inflammatory myofibroblastic tumor (IMT). Two observers retrospectively analyzed images from six MR imaging examinations in four consecutive patients. Tumor location, size, extent, morphology, and number; signal intensity on nonenhanced images; enhancement pattern on serial gadolinium-enhanced images; duct wall thickness; and presence of biliary dilatation, vascular invasion, and lymphadenopathy were assessed. MR imaging findings were compared with histologic findings. On MR images, hepatic IMT manifested as a mass-like lesion in two patients and an area of periportal soft-tissue infiltration in three; one patient had both patterns. Because periportal infiltration is a common feature in both IMT and other malignant tumors of the porta hepatis, histologic examination should be considered before diagnosis and treatment.
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Affiliation(s)
- Shambhavi Venkataraman
- Department of Radiology, University of North Carolina School of Medicine, 101 Manning Dr, 2006 Old Clinic Bldg, CB 7510, Chapel Hill, NC 27599-7510, USA
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28
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Koea JB, Broadhurst GW, Rodgers MS, McCall JL. Inflammatory pseudotumor of the liver: demographics, diagnosis, and the case for nonoperative management. J Am Coll Surg 2003; 196:226-35. [PMID: 12595051 DOI: 10.1016/s1072-7515(02)01495-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inflammatory pseudotumor of the liver (IPL) is an unusual tumor-like condition that is becoming recognized as an important differential diagnosis in the patient presenting with liver masses. This report describes six cases of IPL. STUDY DESIGN Clinical, diagnostic, pathologic, and followup data were collected prospectively on six patients presenting to a specialist hepatobiliary unit. RESULTS Six patients with IPL presented over a 2-year period. Median age was 35 years (range 2 to 79 years) and five patients were men. Three patients were Polynesian (Tongan and Samoan) and one was New Zealand Maori. Five patients presented with nonspecific symptoms (fever, arthralgia, myalgia) and IPL was an incidental finding in one patient. At presentation, four patients had elevated white cell counts, and five patients had abnormal liver function tests with elevations in alkaline phosphotase and gamma-glutamyl transferase the most commonly seen. Carcinogenic embryonic antigen and alpha fetoprotein were normal in all patients, although one was a known hepatitis B carrier. In all cases of IPL, diagnosis was made on core biopsy of the liver lesions and all patients were managed nonoperatively with complete resolution of the tumors. Two patients had marked reduction in systemic symptoms (fever and pain) from a short course of oral steroids. CONCLUSIONS IPL appears to be a relatively common problem in Maori and Polynesians. Recognition and differentiation of this condition from malignant liver lesions are important to avoid unnecessary surgery.
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Affiliation(s)
- Jonathan B Koea
- Upper Gastrointestinal/Hepatobiliary Unit, Department of Surgery, Auckland Hospital, Auckland, New Zealand
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29
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Amankonah TD, Strom CB, Vierling JM, Petrovic LM. Inflammatory pseudotumor of the liver as the first manifestation of Crohn's disease. Am J Gastroenterol 2001; 96:2520-2. [PMID: 11513216 DOI: 10.1111/j.1572-0241.2001.04079.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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30
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Karnak I, Senocak ME, Ciftci AO, Cağlar M, Bingöl-Koloğlu M, Tanyel FC, Büyükpamukçu N. Inflammatory myofibroblastic tumor in children: diagnosis and treatment. J Pediatr Surg 2001; 36:908-12. [PMID: 11381424 DOI: 10.1053/jpsu.2001.23970] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm. Although it is commonly seen in children, the number of childhood cases in the current literature is limited. Furthermore, malignant degeneration or transformation to lymphoma in the recurrent or residual IMT have directed attention to this interesting entity. Herein, the authors present their experience with IMT with special emphasis on diagnosis and treatment. METHODS All records of children treated with diagnosis of IMT between 1977 and 1999 inclusive were evaluated retrospectively. RESULTS Seven children were treated for IMT with the mean age of 9.14 +/- 2 years (range, 6 to 12 years). Male to female ratio was 5:2. Respiratory symptoms and clubbing were present in a patient with pulmonary IMT (n = 1). Abdominal pain (n = 3), fever (n = 2), and weight loss (n = 4) were encountered in intraabdominal IMTs. The most frequent physical finding was palpable intraabdominal mass (n = 4). Plain films showed nonspecific findings such as radiodense area in the hemithorax (n = 1), displacement of bowel segments (n = 2), air-fluid levels (n = 1), and amorphous calcification (n = 4). Ultrasonography and CT showed calcified masses in 4 cases. Except the case with intrathoracic IMT, all the tumors were located in the abdomen at various sites such as cardioesophageal junction (n = 1), left hepatic lobe (n = 1), mesentery of the small bowel (n = 2), and antimesenteric wall of the descending colon (n = 1), gastrosplenic region and porta hepatis (n = 1). Tumor sizes ranged from 3 x 2 x 2 cm to 15 x 15 x 13 cm. The masses were excised totally in all but one case. Infiltrated organs (esophagogastric junction, a segment of jejunum, and spleen, stomach wall, and renal capsule) were resected in 3 cases. Total surgical excision of IMT was considered adequate for treatment in 6 cases. One patient with aggressive IMT required further treatments such as immunomodulation and chemotherapy and died of neutropenic sepsis. CONCLUSIONS IMT is a benign neoplasm rarely presented with malignant features such as local invasiveness, recurrence, distant metastasis, or malignant transformation. IMT can be suspected preoperatively through some hematologic abnormalities and radiologic findings, but precise diagnosis should be made on the basis of histologic findings. Complete surgical resection and close follow-up are all necessary for appropriate treatment to avoid recurrences as well as unnecessary and potentially harmful therapy. The optimal management of locally aggressive and recurrent forms should be decided individually for each patient. J Pediatr Surg 36:908-912.
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Affiliation(s)
- I Karnak
- Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey
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