Multiple inflammatory pseudotumors mimicking liver metastasis from colon cancer: Report of a case

Abstract

A 54-year-old man underwent an operation for colon cancer histologically diagnosed as moderately differentiated adenocarcinoma with clinical staging of Dukes C. He was prescribed carmofur for adjuvant chemotherapy. A follow-up computed tomography scan done 6 months later revealed two new low-density areas in the liver. A diagnosis of metastatic adenocarcinoma from the previous colon cancer was presumed, based on the patient's history and radiological findings, and resection of the affected area of liver was performed. Histological examination of these tumors revealed that they were inflammatory pseudotumors (IPT). The patient had an excellent postoperative course and has shown no further signs of recurrence in the 3 years since his last operation. IPT of the liver is a rare disease, for which no methods of diagnosis and treatment have been established, since it is difficult to distinguish IPT from hepatocellular carcinoma or metastatic carcinoma. We describe this case with a review of the 101 cases of IPT documented in the Japanese literature, in the hope that it will contribute to the diagnosis and treatment of this unusual disease entity.

Inflammatory pseudotumours of the liver: A spectrum of presentation and management options

“…Sakai et al 16 reported on a series of five patients with IPT. CT appearances were of low-density lesions with irregular delayed enhancement as also described by other authors 4,12,16,18,19 . Seki et al 20 , demonstrated peripheral enhancement of IPT in the early phases of dynamic CT in three patients.…”

Inflammatory pseudotumor of the liver associated with malignant disease: report of two cases and a review of the literature

“…Some IPT of the liver have been associated with malignant tumors. In the English-language literature, 6 such cases have been reported [1,7,8,11,13,16] and 4 such cases in the Japanese-language literature [9]. The clinical findings of 10 reported cases and the present 2 cases are summarized in Table 1; 11 cases were reported from Japan and 1 from the United Kingdom.…”

“…In cases 6 and 10, a cystic space was detected in the lesions of the liver, and Staphylococcus aureus was cultured from the cystic fluid in both cases. Obliterating phlebitis was found Ishida et al [7] Saito et al [13] Akiyama et al [1] Kobayashi et al [9] Yokoyama et al [9] Nakamura et al [9] Isobe et al [8] Tajima et al [16] Newbould et al [11] a Cancer stage is classified using TNM Classification of Malignant Tumors (Sixth Edition) from the International Union Against Cancer in case 3 [9] and our present cases (cases 1 and 2). Therefore, the etiology of hepatic IPT may be similar to that of the pyogenic liver abscess because of the similarity of associated cancer types and the etiological correlation of clinical course in some patients.…”

“…In cancer patients, Japanese patients were predominant even in the English-language literature [1,7,8,13,16]. It has been reported that all hepatic IPT patients are predominantly Japanese: 17 of 51 patients (33%) are Japanese [15].…”

“…Some cases of IPT of the liver have been associated with malignant tumors [1, 7-9, 11, 13, 16]. Six such cases have been reported in the English-language literature [1,7,8,11,13,16] and four cases in Japanese-language literature [9], but the etiological correlation between hepatic IPT and liver abscess in cancer patients has never been mentioned. In this paper, we report two cases of IPT of the liver with gastrointestinal tract cancer and discuss the etiological correlation between IPT and abscess of the liver in cancer patients.…”