Selected patients with early-stage primary cancers of the oropharynx may be effectively treated with definitive primary surgery.

Orbital and adnexal Rosai-Dorfman disease is a condition with protean manifestations that may show indolent but unremitting growth despite treatment. The disease may remain extranodal and localized for many years. Adjacent paranasal sinus involvement is commonly seen in conjunction with orbital disease, simulating midline destructive lesions. Surgical debulking gives good results in patients with functional or significant cosmetic problems.

A young woman, aged 18 years, was investigated because of an intermittent fever, dyspnea, malaise, anorexia and weight loss (5 kg) over the preceding 3 months. She had been taking an oral contraceptive pill for endometriosis. On examination, the only abnormal findings were a temperature of 38.3∞C and a pulse rate of 120 per minute. Investigations revealed a hemoglobin count of 72 g/L (microcytic, hypochromic) with a white cell count of 14.5, an ESR >100 mm/h and a CRP of 180 mg/L. Serum bilirubin and liver enzymes were normal but she had a low plasma albumin (31 g/L) and a prolonged INR (1.5). Blood cultures were negative, yet a bone marrow biopsy and serological tests for various infections were unhelpful. A computed tomography scan during the arterial phase showed a lesion, approximately 3 cm in diameter, involving segments 7 and 8 in the right lobe of the liver. There was central enhancement with a low-density rim and faint surrounding enhancement. As a laparoscopic biopsy of the lesion was nondiagnostic, the lesion was removed by segmental resection. The macroscopic appearance of the lesion is shown in Figure 1. Histological examination revealed fibrous connective tissue, discrete collections of myofibroblasts and fibroblasts, and an infiltrate of chronic inflammatory cells with a predominance of plasma cells (Fig. 2). The diagnosis was that of an inflammatory pseudotumor of the liver. After surgery, her symptoms resolved and her hemoglobin returned to normal.Although inflammatory pseudotumors of the liver are rare, the diagnosis should be considered in patients with a systemic illness, an inflammatory blood picture and a solid liver lesion. The major differential diagnoses are hepatocellular carcinoma, hepatoblastoma, embryonal sarcoma and lymphoma. Unfortunately, there are no diagnostic features on imaging studies. In relation to management, surgery appears to be curative in most cases although local recurrence has been reported. Figure 1Figure 2