Hepatic Inflammatory Pseudotumor Associated with Xanthogranulomatous Cholangitis Mimicking Cholangiocarcinoma

Abstract

Inflammatory pseudotumor (IPT) is a rare benign condition often misdiagnosed as malignancy. An 80-year-old man was referred to our clinic for an asymptomatic hepatic mass detected on plain abdominal CT. Abdominal ultrasonography identified the lesion as a poorly defined hypoechoic mass. Although a liver biopsy did not provide any evidence of malignancy, imaging modalities suggested a diagnosis of cholangiocarcinoma. The patient underwent left lobectomy, and the pathological findings were consistent with the features of xanthogranulomatous cholangitis. This case is the first report of hepatic IPT originating from xanthogranulomatous cholangitis without symptoms and illustrates the importance of obtaining a preoperative diagnosis in order to avoid a misdiagnosis of malignant tumor.

Hepatic Inflammatory Pseudotumor Protruding from the Liver Surface and Directly Penetrating the Colon

“…The etiology of hepatic IPT remains unknown. However, several factors, such as infection, trauma, biliary obstruction and cholangitis, autoimmune disorders, hepatitis B virus, hepatitis C virus, IgG4-related cholangitis and primary sclerosing cholangitis, are thought to be closely related to hepatic IPT (12)(13)(14). The present case had undergone percutaneous transhepatic liver abscess drainage six months earlier.…”

“…It has been reported that most cases with hepatic IPT were diagnosed after surgical resection (14). This is because of the lack of accurate diagnostic imaging methods.…”

“…Therefore, differentiation between hepatic IPT and other liver diseases seems to be easy. However, many cases with hepatic IPT are diagnosed postoperatively rather than preoperatively (14). Although a US-guided percutaneous biopsy plays an important role in making a diagnosis of liver lesions in general, its diagnostic accuracy regarding hepatic IPT is insufficient (23).…”

Recurrent Hepatic Inflammatory Pseudotumor in Asynchronism After Surgery of Inflammatory Pseudotumor Associated With Granulomatous Cholangitis

“…Due to its ambiguity, the lesion completely resolves in some patients receiving antibiotics and/or corticosteroids, but some lesions recur [15][16][17]. Numerous studies have suggested surgery as the treatment of choice, particularly for patients with severe symptoms or an indeterminate diagnosis [1,18,19].…”

“…Inflammatory pseudotumor (IPT) is a rare benign condition reported in almost all organs, including occasionally in the liver [1]. IPT was first described in the lung in 1939 and liver involvement was first described in 1953 [2,3].…”