Inflammatory pseudotumor of the liver: a case report and review of the literature

Abstract

IntroductionInflammatory pseudotumor of the liver represents a fairly uncommon pathology. Although it is a benign tumor, the correct diagnosis can be missed.Case presentationWe 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.ConclusionAlthough 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.

Inflammatory Pseudotumor of the Liver in Patient with Type 2 Diabetes

“…Many mechanisms and hypothesized etiologic factors like infections, trauma, autoimmunity reactions, radiotherapy, and local reaction to changes in the walls of bile ducts are suggested [1][2][3][4][5][6][7]10,13,[18][19][20][21][22][23][24][25][26]. Some microorganisms that access the portal vein including Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Gram-positive cocci and Actinomyces were regarded as causative agents.…”

“…Viral infections (Epstein-Barr virus [20], hepatitis B and C virus) [10,27] and parasitic infestations (Schistosoma mansoni) may play role in the pathogenesis [18]. Some authors suggested that disturbance of biliary drainage, e.g., due to biliary stones [1,7], recurrent pyogenic cholangitis [4,26] or sclerosing cholangitis is also important [25]. The tumor was also noted in HIV infected persons [24].…”

“…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.…”

“…It may arise in nearly every site of the body (e.g. breast, kidney, thyroid, salivary glands, larynx, spleen, stomach, brain, omentum, mesentery, orbit), but most commonly develops in the lung and the liver [1][2][3][4][5][6][7][8]. The first description of hepatic localization appeared in 1953 [9].…”

“…In most cases it affects adults, but in Asia, the hepatic IPT occurs often in children and young adult persons [2,6]. IPT usually presents as an asymptomatic [5], slowly growing, unilateral mass accompanied by unspecific symptoms like fever, malaise, abdominal pain and rarely vomiting, jaundice and weight loss [3,4,6,7,10]. It typically forms the solitary large (maximum dimension range from 2 to 22 cm) mass and accounts for 0.4% of all focal liver lesions [2,7].…”