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Case Reports
. 2021 Aug 23;14(8):e244572.
doi: 10.1136/bcr-2021-244572.

IgG4-related hepatic inflammatory pseudotumour: could MRI suggest the correct diagnosis?

Ana Primitivo  1 , Maria Helena Oliveira  2 , Afonso Gonçalves  3   4
Affiliations
Case Reports

IgG4-related hepatic inflammatory pseudotumour: could MRI suggest the correct diagnosis?

Ana Primitivo et al. BMJ Case Rep. .

Abstract

We report a case of a 62-year-old woman, HIV positive, with a 3-week history of jaundice and elevated cholestatic enzymes. Imaging studies displayed intrahepatic biliary dilatation and a central liver lesion. Pathology described lesions of active cholangitis, lymphoplasmacytic infiltration and fibrosis, suggesting a hepatic inflammatory pseudotumour (IPT) IgG4 related. IgG4-related lymphoplasmacytic form of IPT belongs to IgG4-related diseases. We discuss the importance to include IgG4-related hepatic IPT as part of the differential diagnosis of any liver lesion, highlighting potential imaging clues that may help in establishing the correct diagnosis.

Keywords: gastrointestinal system; liver disease; radiology (diagnostics).

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A and B) Mild intrahepatic biliary dilatation without dilatation of the common bile duct. There was a central perihilar area, ill-defined, with heterogeneous echoes. The common bile duct showed diffuse parietal thickening which was dismissed at the onset (arrow in B).
Figure 2
Figure 2
(A, B and C) Mild intrahepatic biliary dilatation with a central and isodense lesion, depicting mild late enhancement at the periphery of the lesion (C).
Figure 3
Figure 3
The central liver mass is isointense in T1-WI (A) and T2-WI (B). Cholangiography sequence confirms the intrahepatic biliary dilatation with central abrupt cut-off lesion (C). T1-WI after gadolinium injection in arterial (D), portal venous (E) and delayed (F) phases depicts mild late capsule-like enhancement. WI, weighted-image.
Figure 4
Figure 4
(A) A proliferation of fibroblasts and inflammatory cells (mostly lymphocytes and plasma cells) around bile ducts. Immunohistochemistry (B) demonstrates plasma cells positive for anti-IgG4 antibody, confirming the diagnosis of inflammatory pseudotumour IgG4 related. H&E staining, 100× magnification.
Figure 5
Figure 5
Axial CT image, portal venous phase, 3 months after the onset, depicting complete imaging response.
See this image and copyright information in PMC

References

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