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Multicenter Study
. 2014 Jan;8(1):58-63.
doi: 10.5009/gnl.2014.8.1.58. Epub 2013 Nov 21.

Clinical features, image findings, and prognosis of inflammatory pseudotumor of the liver: a multicenter experience of 45 cases

Jun Young Park  1 , Moon Seok Choi  1 , Young-Suk Lim  2 , Jang Won Park  2 , Seung Up Kim  3 , Yang Won Min  1 , Geum-Youn Gwak  1 , Yong-Han Paik  1 , Joon Hyoek Lee  1 , Kwang Cheol Koh  1 , Seung Woon Paik  1 , Byung Chul Yoo  1
Affiliations
Multicenter Study

Clinical features, image findings, and prognosis of inflammatory pseudotumor of the liver: a multicenter experience of 45 cases

Jun Young Park et al. Gut Liver. 2014 Jan.

Abstract

Background/aims: Inflammatory pseudotumor (IPT) of the liver is a rare disease characterized by chronic infiltration of inflammatory cells. However, the clinical characteristics and outcomes of IPT remain uncertain.

Methods: Clinical features, image findings, and outcomes of 55 patients with histologically proven IPT were evaluated.

Results: They consisted of 26 men and 19 women with median age of 65 years. Serum carcinoembryonal antigen and carbohydrate antigen 19-9 levels were normal in 42 patients (93.3%). Enhanced CT scans indicated poorly defined peripheral enhancement (82.5%) at the arterial phase and poorly defined hyperattenuating lesions with internal hypoattenuating areas at the equilibrium phase (77.0%). Gadolinium-enhancement MRI revealed poorly defined peripheral rim-like enhancement (77.8%). Ten patients underwent surgical resection and 35 were treated conservatively with or without antibiotics. No recurrence was noted after surgical resection during follow-up (1 to 48 months). In all patients who received conservative treatment, complete resolution or size reduction was noted during follow-up (1 to 192 months).

Conclusions: CT and MRI provide clues to the diagnosis of IPT in patients with liver masses and normal tumor markers. However, due to the lack of pathognomonic findings, the clinician's suspicion and histological diagnosis are necessary to make an accurate diagnosis of IPT.

Keywords: Inflammatory pseudotumor; Liver.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Image findings in a 41-year-old man with two surgically proven inflammatory pseudotumors of the liver. (A) A 3.8-cm mass (S7) and another 4.7-cm-sized mass (S8) of low attenuation were noted on precontrast computed tomographic (CT) images. (B) On contrast-enhanced CT imaging, the masses exhibited central enhancement in the arterial phase and (C) peripheral enhancement in the delayed phase. (D) In gadolinium-enhanced magnetic resonance imaging, the masses exhibit low signal intensity in T1-weighted images, (E) intermediate high signal intensity in T2-weighted images, (F) and low signal intensity in the central portion with ill-defined hyperintensity in the delayed phase.
Fig. 2
Fig. 2
Histological findings of a 41-year-old man with two surgically proven inflammatory pseudotumors of the liver. (A) The lesions contained a mixture of inflammatory cells with a predominance of mature plasma cells (H&E stain, ×50). (B) Lymphocytes with lymphoid follicles, neutrophils, and eosinophils were also noted. These inflammatory cells infiltrated the stroma, composed of interlacing bundles of fibroblasts and collagen bundles (H&E stain, ×200).
See this image and copyright information in PMC

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