Inflammatory Pseudo-tumor of the Liver Accompanied by Eosinophilia

Abstract

A 28-year-old woman was referred to our hospital for liver dysfunction and neck pain. Blood tests revealed elevated liver enzymes and eosinophilia. Ultrasonography, computed tomography, and magnetic resonance imaging showed a mass lesion near the hepatic hilus. The tumor was considered to be an inflammatory pseudo-tumor or malignancy. A liver-mass biopsy was performed and led to a diagnosis of inflammatory pseudo-tumor. In the present case, a markedly elevated eosinophil count was a characteristic clinical feature, and the patient underwent steroid therapy. Treatment resulted in a reduced eosinophil count, improved neck symptoms, and disappearance of the inflammatory pseudo-tumor.

Keywords: eosinophilia; inflammatory pseudo-tumor; liver dysfunction.

Figure 1.

Abdominal ultrasonography (US) image showing a low-echoic mass lesion (arrow) (A), sonazoid-enhanced US image showing a high-echoic mass lesion at the early vascular phase (B), and sonazoid-enhanced US image showing a hypoechoic mass lesion at the post-vascular phase (C).

Figure 2.

Computed tomography (CT) image of the abdomen showing a mass located near the porta hepatis (arrow) in the plain image (A), the arterial phase (B), and the equilibrium phase (C).

Figure 3.

Abdominal magnetic resonance imaging (MRI) showing a mild hypointense mass (arrow) on T1-weighted imaging (A), a slightly higher-signal-intensity mass on T2-weighted imaging (B), a mass with rim-like enhancement on dynamic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI (EOB-MRI) (early phase) (C), and a hyperintense mass with an internal hypointense area on dynamic EOB-MRI (hepatobiliary phase) (D).

Figure 4.

Hematoxylin and Eosin staining showing the presence of inflammatory cell infiltration (A, low-power field; B, high-power field). Immunohistochemistry showing alpha-SMA (C), IgG (D), and IgG4 (E).