Inflammatory myofibroblastic tumor of the liver: A case report and review of literature

Table 2 Clinical studies of > 2 patients

Ref.	n	Age (yr)	Gender	Clinical and laboratory findings	Radiology	Localization	Tentative diagnose	Treatment	Histology	Follow up
Park et al [28], 2014	45	65 (29-84)	Male/female (26/19)	Abdominal pain (n = 16) fever (n = 11), malaise (n = 5) weight loss (n = 4); CRP↑ (n = 31), leukocytosis (n = 10), CEA (n = 1) CA 19-9 (n = 1); hypertension, tuberculosis, chronic Hepatitis B	CT scan: Hypo-attenuating lesions in 40 patients, MRI: Low signal intensity lesion at T1W image in 86.4% and relatively homogenous high signal intensity lesion at T2W image in 76.2%	Right lobe (n = 27), left lobe (n = 14), both (n = 4)	Malignancy (n = 26, 57.8%), abscess (n = 11, 24.4%)	Percutaneous needle biopsy (n = 35), surgical resection (n = 9), both (n = 1)	Chronic infiltration of various inflammatory cells (plasma cells, lymphocytes, neutrophils, and eosinophils) and fibrous stroma	No recurrence after median follow-up of 8 mo
Ahn et al [42], 2011	22	34- 76	Male/ female (16/6)	Abdominal pain (n = 12), febrile (n = 5), malaise (n = 1), asymptomatic (n = 4), leucocytosis (n = 6), hyperbilirubinaemia (n = 3), alkaline phosphatase↑ (n = 10), liver enzymes ↑ (n = 5), CA 19-9 ↑ (n = 5), AFP↑ (n = 1) ; associated biliary disease (n = 15), malignancy (n = 4)	Solitary (n = 17); multiple (n = 5), median size 3 cm (1.1-9.6 cm), non-enhanced CT: Hypoattenuating lesions (n = 22), enhanced CT: Central hypoattenuating areas and a delayed hyperattenuating periphery (n = 18), multiseptate appearance with hyperattenuating internal septa and periphery (n = 3), hypoattenuation up to the equilibrium phase (n = 1)	Right lobe n = 10, left lobe n = 9, both n = 3, (mostly seg. IV n = 12)	IPT (n = 12), malignancy (n = 4), recurrence of malignancy (n = 2), abscess (n = 4)	Percutaneous needle biopsy (n = 18), incisional biopsy (n = 1) --> surgical resection (n = 3); liver resection (n = 3) without prior biopsy, 16 patients conservatively, 6 patients with surgical resection	Histiocytic cell infiltration with negative IgG4 (n = 17), lymphoplasmacytic type (n = 5) with positive IgG4 (n = 4)	Post conservative treatment: 10 complete remission after 15 mo; 5 partial remission after 4 mo, post resection: Mortality n = 2 (myocardial infarction, peritoneal seeding)
Geramizadeh et al [44], 2009	2	14	Male	Chills, fever, anorexia > 8 kg weight, leukocytosis	CT: Well-defined heterogeneous mass with central areas of necrosis and a slightly hyperdense rim	Left lobe	Abscess	Resection	Creamy grey mass with a vague whorling appearance. Plasma cells with varying degrees of fibroblastic proliferation admixed with lymphocytes, eosinophils and macrophages	No recurrence after 1 yr
		15	Male	Hepatitis B positive, weight loss	Well defined liver mass	NM	Malignancy	Fine needle biopsy	6 cm liver mass, fibroblastic proliferation, many plasma cells and eosinophils	No recurrence after 2 yr
Yamaguchi et al [17], 2007	3	52	Male	Epigastric pain, appetite loss, weight loss, fever	U/S and CT: Hepatic mass in left lobe	Left lobe	IPT	Follow up	NM	Complete remission after 1 yr
		58	Male	Auxiliary finding	CT: Low density mass in the right lobe enhanced during the delayed phase	Right lobe	CCC	Biopsy > no treatment, follow up	IMTL	NM
		57	Female	Sigmoid cancer planned for resection	MRI: 2 metastases with low-intensity signal on T1, a slightly high-intensity signal on T2	Right lobe	Hepatic metastasis	Intraoperative right portal vein embolization	NM	NM
Milias et al[46], 2009	4	35	Male	Abdominal and bone pain, fatigue, malaise, hematuria, WBC↑	CT: Liver abscess right upper abdominal quadrant	Right lobe	Liver abscess	Drainage followed by right hepatectomy	Many plasma cells, densely collagenous bundles between a plasma cell-rich infiltrate	NM
		56	Male	Right upper abdominal pain, malaise	CT: Liver abscess	Right lobe	Liver abscess	Drainage followed by right hepatectomy	Inflammatory response to hepatic abscess
		75	Female	Moderate upper quadrant pain, nausea, and vomiting	U/S: Cystic lesion, CT: Cystic lesion, slight dilatation of intrahepatic bile ducts	IVB	Cholangitis/ Cystadenoma	Biopsy followed by Seg. IVB resection	Central granulation, fibrosis and chronic lymphoplasmacytic infiltrate, no features of neoplasia. Inflammatory pseudotumor
		47	Female	Right upper quadrant pain, jaundice, fever, pruritus	CT: Marked dilatation of the intrahepatic biliary tree	Right lobe	CCC	Seg. III resection, secondary right hepatectomy	Widespread chronic inflammatory infiltrate with lymphocytes and plasma cells, numerous lipid-laden macrophages, no malignancy

CT: Computed tomography; MRI: Magnetic resonance imaging; FUO: Fever unknown origin; CRP: C-reactive protein; CCC: Cholangiocarcinoma; HCC: Hepatocellular carcinoma; PTCD: Percutaneous transhepatic cholangio drainage; NM: Not mentioned; U/S: Ultrasonography; Hb: Haemoglobin; LC: Leukocytes; TC: Thrombocytes; T1W: T1-Weighted; T2W: T2-Weighted; Chron Hep B: Chronic Hepatitis B; Seg: Segment; ↑: Increase; ↓: Decrease; WBC: Wight blood cell.