Published online Jul 28, 2015. doi: 10.3748/wjg.v21.i28.8730
Peer-review started: December 17, 2014
First decision: January 22, 2015
Revised: February 22, 2015
Accepted: March 30, 2015
Article in press: March 31, 2015
Published online: July 28, 2015
Processing time: 225 Days and 4.1 Hours
Hepatic inflammatory pseudotumors are uncommon benign lesions. Accurately diagnosing hepatic inflammatory pseudotumor can be very challenging because the clinical presentation and radiological appearances are nonspecific and cannot be certainly distinguished from malignant neoplastic processes. Herein, we present a case of hepatic IPT in an 8-year-old boy who presented to clinic with a 3-mo history of a tender hepatic mass, fever of unknown origin, and 9-kg weight loss. The physical examination was notable for tender hepatomegaly. Laboratory investigations were notable for a normal hepatic profile and elevated erythrocyte sedimentation rate and C-reactive protein. A T2-attenuated magnetic resonance imaging scan of the abdomen showed a 4.7 cm × 4.7 cm × 6.6 cm, contrast-enhancing, hyper-intense, well-defined lesion involving the right hepatic lobe. In view of the unremitting symptoms, tender hepatomegaly, thrombosed right hepatic vein, nonspecific radiological findings, and high suspicion of a deep-seated underlying infection or malignancy, a right hepatic lobectomy was recommended. Microscopically, the hepatic lesion exhibited a mixture of inflammatory cells (histiocytes, plasma cells, mature lymphocytes, and occasional multinucleated giant cells) in a background of dense fibrous tissue. Immunohistochemically, the cells stained negative for SMA, ALK-1, CD-21 and CD-23, diffusely positive for CD-68, and focally positive for IgG4. The final histopathological diagnosis was consistent with hepatic IPT. At the postoperative 4-mo follow-up, the patient was asymptomatic without radiological evidence of recurrence.
Core tip: Because hepatic inflammatory pseudotumors (IPTs) are considered benign lesions and their natural clinical course advances toward regression, it is extremely critical to establish the most accurate diagnosis and not to regard them as malignant neoplasms that may lead to needless surgical excisions. However, accurately diagnosing hepatic IPTs can be very challenging, likely attributable to the fact that the clinical presentation and radiological appearances are nonspecific and cannot be certainly distinguished from malignant neoplastic processes. Management options include conservative treatment, and if failed, surgical resection. Histopathological and immunohistochemical analysis of the hepatic lesion yields the definitive diagnosis.