Different imaging findings of inflammatory myofibroblastic tumor of the liver

Abstract

Inflammatory myofibroblastic tumor (IMT) in the liver is an uncommon lesion of uncertain pathogenesis. In most cases, symptomatological imaging and clinical studies suggest malignancy. We report a case of liver IMT with imaging findings from positron emission tomography/computed tomography (PET/CT), contrast-enhanced computed tomography (CECT) and contrast-enhanced ultrasonography (CEUS). This report was the first to depict a PET/CT scan of a liver IMT that revealed an inhomogeneous, intense (fluorine 18)-fluoro-2-deoxy-D-glucose uptake. The CECT and CEUS images showed a hepatic artery supplying blood to the mass and necrosis. The characteristic histopathological features and the presence of spindle cells expressing smooth muscle actin, collagen fibers and lymphocytes allowed for the diagnosis of liver IMT. Recognizing such findings will help to achieve a correct diagnosis and may prevent inappropriate treatment.

Inflammatory Myofibroblastic Tumor of Liver Masquerading as Focal Nodular Hyperplasia in a Patient with Non-Cirrhotic Portal Hypertension and Biliary Pancreatitis

“…Patients with hepatic IMT may be asymptomatic or may present with right upper quadrant pain, fever, jaundice, and, occasionally, obliterative phlebitis [1]. Laboratory findings include leukocytosis, anemia, thrombocytosis, polyclonal hypergammaglobulinemia, and elevated ESR and C-reactive protein [14]. Occasionally slight elevation of liver enzymes may also be noted.…”

“…Originally described in the lung, IMT has since been encountered in multiple other locations, most commonly the mesentery of the small intestine and omentum predominantly in children and young adults [2]. Although hepatic involvement was first described way back in 1953 by Pack and Baker [5], literature is sparse on the subject and limited to a few anecdotal case reports and retrospective reviews signifying its rarity [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Herein, we present a case of hepatic IMT in a patient with non-cirrhotic portal hypertension (NCPH) and biliary pancreatitis masquerading as focal nodular hyperplasia (FNH) which showed spontaneous regression on follow-up imaging.…”

Inflammatory Pseudotumor of the Liver in Patient with Type 2 Diabetes

“…Furthermore, both clinical presentation and radiological images may be suggestive for malignancy [4,[11][12][13]15,16,22,27,30,31 ]. In the liver IPT has to be distinguished from hepatocellular carcinoma [15,16,27], intrahepatic cholangiocarcinoma [11,13], metastases [12,30] and inflammatory conditions mostly abscesses [17,22]. For this reason IPT is sometimes called 'the great mimicker" [22].…”

“…plasma cell granuloma, inflammatory myofibroblastic tumor, histiocytoma, fibroxanthoma, xanthogranuloma or plasma cell histiocytoma [1][2][3][4][5]10,17,18,31,33]. According to the current WHO classification of the digestive system tumor [2], it is defined as a mesenchymal, benign, non-neoplastic and non-metastasizing mass composed of fibrous tissue and proliferated myofibroblasts with a marked inflammatory infiltration, predominantly of plasma cells.…”

“…Majority cases are located in the right lobe. Radiological findings of the IPT are nonspecific but benign histopathological features constitute the hallmark of this lesion [12][13][14]16,17].…”