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Case Reports
. 2014 May 6:12:140.
doi: 10.1186/1477-7819-12-140.

Inflammatory pseudotumor of the liver diagnosed as metastatic liver tumor in a patient with a gastrointestinal stromal tumor of the rectum: report of a case

Yoichi Matsuo  1 , Mikinori Sato, Takahiro Shibata, Mamoru Morimoto, Ken Tsuboi, Tomoya Shamoto, Takahisa Hirokawa, Takafumi Sato, Hiroki Takahashi, Hiromitsu Takeyama
Affiliations
Case Reports

Inflammatory pseudotumor of the liver diagnosed as metastatic liver tumor in a patient with a gastrointestinal stromal tumor of the rectum: report of a case

Yoichi Matsuo et al. World J Surg Oncol. .

Abstract

Background: Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion. A case of IPT of the liver found in association with a malignant gastrointestinal stromal tumor (GIST) is reported.

Case report: A 74-year-old man was admitted to our hospital for a liver tumor. He previously underwent rectal amputation for a malignant GIST. Computed tomography (CT) revealed a low-density area in the liver and dynamic contrast-enhanced MRI (EOB-MRI) showed that the tumor was completely washed out in the delayed phase. 18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) showed strong uptake in the liver. A diagnosis of liver metastasis was made and partial hepatectomy was performed. Microscopic examination showed that the tumor was an IPT.

Conclusion: Differential diagnosis between IPT and malignant neoplasms is difficult. Moreover, FDG-PET revealed strong uptake in the tumor. To our knowledge, this is the first patient reported to have an IPT in association with a rectal GIST. This patient is discussed along with a review of the literature.

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Figures

Figure 1
Figure 1
Computed tomography (CT) findings nine years after the first surgery. A 14-mm low-density area (arrow) in segment 8 of the liver (plane) is observed. The periphery of this area was nonhomogeneously enhanced by contrast medium and appeared to be isodense in the late phase (arrow head) compared to surrounding normal liver tissue.
Figure 2
Figure 2
Dynamic contrast-enhanced magnetic resonance imaging (MRI) findings with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (EOB-MRI). EOB-MRI showed that the tumor appears isointense in the arterial phase (arrow) and was completely washed out in the delayed and hepatocyte phases (arrow head).
Figure 3
Figure 3
18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) findings. FDG-PET showed strong uptake in the liver (arrow). No other abnormal uptake was observed.
Figure 4
Figure 4
A cross section of the resected liver. The tumor was well-circumscribed, solid, and yellowish-white in color. No evidence of necrosis or hemorrhage was present.
Figure 5
Figure 5
Pathological findings. (a) microscopic examination of the paraffin section of the liver ‘tumor’ showed that it was composed of fascicles of spindle cells such as fibroblasts and myofibroblasts accompanied by many lymphocytes, plasma cell, neutrophils, and macrophages. No mitotic cells were observed in these spindle cells (H&E stain, ×200). Immunohistochemical (IHC) studies of spindle cells showed positive staining for smooth muscle actin (SMA) (b) and negative staining for desmin (c) and CD34 (d). IHC studies of white blood cells revealed that the majority of lymphocytes expressed CD3 (e) and some cells expressed CD20 (f). Moreover, IHC showed some IgG4-positive plasma cells (g).
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