Inflammatory pseudotumor of the liver and spleen diagnosed by percutaneous needle biopsy

Abstract

An inflammatory pseudotumor (IPT) is a relatively rare lesion characterized by chronic infiltration of inflammatory cells and areas of fibrosis. IPTs are difficult to diagnose because of the absence of specific symptoms or of characteristic hematological or radiological findings. In this study, a case of a woman aged over 70 years was reported, who presented with a general malaise lasting more than two months. A computed tomography scan demonstrated a diffusely spread lesion of the liver with a portal vein occlusion and a splenic lesion surrounded by a soft density layer. Since the percutaneous liver biopsy showed findings that suggested an IPT, although the radiological findings did not exclude the possibility of a malignancy, we performed a percutaneous spleen biopsy to enable a more definitive diagnosis. The microscopic findings from the spleen specimen lead us to a diagnosis of IPT involving the liver and spleen. Subsequent steroid pulse therapy was effective, and rapid resolution of the disease was observed.

Keywords: Inflammatory pseudotumor; Percutaneous liver biopsy; Percutaneous spleen biopsy; Steroid pulse therapy.

Figure 1

Contrast computed tomography scanning of the arterial phase revealed a diffusely and non-homogeneously enhanced liver, with the anterior compartment showing less enhancement (arrow-head). The spleen was found to be protruding inward, and also showed a diffuse and inhomogeneous enhancement. A: Computed tomography (CT) scans also revealed a soft density layer around the spleen (arrow). B: A CT of the portal phase showed an occlusion (arrow) of the left branch of the portal vein.

Figure 2

Fluorodeoxyglucose positron emission tomography/computed tomography analysis showing abnormal metabolic activity with a high standardized uptake value of 7.1 surrounding the spleen (A), and multiple abnormal uptakes in segment six of the liver (B).

Figure 3

Histological findings for the liver via hematoxylin and eosin staining showing patchy fibroses and inflammatory cell infiltration (original magnification × 100). A: Mainly consisting of lymphocytes and plasma cells (original magnification × 200); B and C: Histological findings for the spleen following HE staining showed infiltration by plasma cells (original magnification × 200); D-I: Immunohistochemical analysis of the liver showed that the lesion was positive for CD68 (D), α-smooth muscle actin (SMA) (E), and IgG (F), but not for IgG4 (G), anaplastic lymphoma kinase (ALK) (H), or Epstein-Barr virus (EBV) encoded RNA (EBER) (I). HE: Hematoxylin and eosin.

Figure 4

Chest X-ray showing massive pleural effusion of the left side before treatment (A), and full correction following steroid pulse therapy (B).

Figure 5

Follow-up computed tomography showing nearly complete resolution of the hepatic and splenic lesions other than the remaining soft density layer around the spleen (arrow).