Inflammatory pseudotumor of the liver successfully treated with nonsteroidal anti-inflammatory drugs: A challenge diagnosis for one not so rare entity

Abstract

Inflammatory pseudotumor of the liver is a rare, benign lesion characterized by a well-circumscribed mass of chronic inflammatory cell infiltration and proliferating fibrous tissue. Its etiology remains unclear, although inflammatory processes have been proposed. It is often misdiagnosed as a malignant tumor, and the management has been traditionally surgical. We report the case of a 16-year-old boy who was referred from another hospital with a fever of >38 degrees C with rigor and right upper quadrant pain which he had suffered from for 5 days. The ultrasonographic computed tomography and MRI findings were not diagnostic, and we performed a needle biopsy from the lesion that was consistent with inflammatory pseudotumor (of liver, mixed fibrous tissue and chronic inflammatory cell infiltration). The patient was treated with nonsteroidal anti-inflammatory drugs and had an uneventful clinical course. During follow-up, the lesion subsequently shrank to completely vanish 1 year later.

Inflammatory pseudotumor of the liver diagnosed by needle biopsy: Report of three cases (one with neuroendocrine tumor of the rectum and lung)

“…Three types of cancer patients have been documented in IPT of the liver: gastrointestinal tract cancer patients including gastrointestinal stromal tumor (GIST) (12), biliary tract cancer patients and patients who received systemic chemotherapy (13). Probable septic origin, hepatic abscess or infection through the portal vein causing IPT of the liver has been widely suggested, but no definitive microorganisms could be isolated from the specimens in most cases (12,15). Also, in our first case, it would be hard to suggest that an 8 mm polypoid-shaped neuroendocrine tumor of the colon could have assisted the entry of the enteric microorganisms into the portal vein to support an infectious etiology.…”

“…Surgical treatment, which is generally regarded as over-treatment, should be considered if IPT does not respond to medical therapy (1, 12), causes major complications such as biliary obstruction and portal hypertension (12), or when the definitive diagnosis cannot be made by needle bi- opsy (15). Hence, the diagnosis of IPT on percutaneous needle biopsy is important to avoid unnecessary exploratory laparotomy or hepatectomy (1).…”

Successful Treatment of an Unresectable Inflammatory Myofibroblastic Tumor of the Frontal Bone Using a Cyclooxygenase-2 Inhibitor and Methotrexate

“…There are case reports of IMT being successfully treated with nonsteroidal anti- inflammatory drugs (NSAIDs) and COX-2 inhibitors (Table) (11)(12)(13)(14)(15)(16)(17)(18)(19). Furthermore, we found several cases of IMT that were successfully treated with NSAIDs or a COX-2 inhibitor without the use of any surgery or any other medications.…”

Inflammatory tumors of the digestive tract

“…[46] из клиники Мейо сооб-щили об обнадеживающих результатах включения НПВП (инги-битора циклооксигеназы-2 целекоксиба) в стандартный режим ПХТ сарком (винкристин, ифосфамид, доксорубицин) у 5-летне-го ребенка с мультфокальными метастазами по плевре ВМО лег-кого, выявленными через 11 мес после хирургического лечения, добившись 4-летней продолжающейся ремиссии, что согласуется с результатами иранских педиатров [18]. Единичные наблюдения иллюстрируют эффективность монотерапии НПВП в лечении нерезектабельных первичных ВМО печени [47,48], нерезекта-бельных абдоминальных [49] и повторных рецидивных ВМО лег-ких [50].…”