Abstract
Background
Inflammatory pseudotumor (IPT) of the liver is a benign condition with a good prognosis. However, it is difficult to distinguish clinical and radiological findings of IPT from those of malignancies. The aims of this study are to determine the clinical, radiological, and pathological characteristics, particularly relating to the role of the autoimmune mechanism in the development of inflammatory pseudotumours (IPTs) of the liver, and to suggest appropriate diagnostic and therapeutic strategy.
Study design
The clinical, diagnostic, and pathological characteristics including IgG4 immunohistochemical stain and follow-up data of 22 IPT patients were retrospectively analyzed.
Results
The patients were 16 men and 6 women with a mean age of 59 years. Fifteen patients (68.2%) had associated biliary diseases. Of the 16 patients treated conservatively, the masses completely resolved in 10 patients, and reduced in size in 5 patients within the first 6 months. The remaining 6 patients were treated by surgical resection. IgG4 staining of 17 tissue samples from 22 patients were negative, most of the infiltrate being of fibrohistiocytic type, whereas 4 of 5 lymphoplasmacytic cells of dominant tumors show positive staining of IgG4. Although IgG4-related sclerosing cholangitis was mostly of lymphoplasmacytic type, other histological and clinical characteristics were similar in both types of IPTs.
Conclusions
IPTs of the liver can be diagnosed based on radiological and pathological findings by needle biopsy. Although the lymphoplasmacytic type of IPTs seems to correspond to IgG4-related disease, as assessed by IgG4 immunohistochemical stain, its clinical significance is unknown. Although most IPTs can be resolved with conservative therapy, surgical resection should be considered in cases of uncertain biopsy result, presumed malignant lesion, combination with other pathology, or lack of response to conservative management.
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References
Torzilli G, Inoue K, Midorikawa Y, et al. Inflammatory pseudotumors of the liver: prevalence and clinical impact in surgical patients. Hepatogastroenterology. 2001;48:1118–23.
Melloni G, Carretta A, Ciriaco P, et al. Inflammatory pseudotumor of the lung in adults. Ann Thorac Surg. 2005;79:426–32.
Coffin CM, Humphrey PA, Dehner LP. Extrapulmonary inflammatory myofibroblastic tumor: a clinical and pathological survey. Semin Diagn Pathol. 1998;15:85–101.
Horiuchi R, Uchida T, Kojima T, Shikata T. Inflammatory pseudotumor of the liver. Clinicopathologic study and review of the literature. Cancer. 1990;65:1583–90.
Kim SR, Hayashi Y, Kudo M, et al. Inflammatory pseudotumor of the liver in a patient with chronic hepatitis C: difficulty in differentiating it from hepatocellular carcinoma. Pathol Int. 1999;49:726–30.
Kitajima K, Shiba H, Nojiri T, et al. Intrahepatic cholangiocarcinoma mimicking hepatic inflammatory pseudotumor. J Gastrointest Surg. 2007;11:398–402.
Ishida H, Tatsuta M, Furukawa H, et al. Multiple inflammatory pseudotumors mimicking liver metastasis from colon cancer: report of a case. Surg Today. 2000;30:530–3.
Pack GT, Baker HW. Total right hepatic lobectomy: report of a case. Ann Surg. 1953;69:176–81.
Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344:732–8.
Kamisawa T, Funata N, Hayashi Y, et al. Close relationship between autoimmune pancreatitis and multifocal fibrosclerosis. Gut. 2003;52:683–7.
Yamamoto H, Yamaguchi H, Aishima S, et al. Inflammatory myofibroblastic tumor versus IgG4-related sclerosing disease and inflammatory pseudotumor: a comparative clinicopathologic study. Am J Surg Pathol. 2009;33:1330–40.
Zen Y, Fujii T, Sato Y, et al. Pathological classification of hepatic inflammatory pseudotumor with respect to IgG4-related disease. Mod Pathol. 2007;20:884–94.
Zen Y, Harada K, Sasaki M, et al. IgG4-related sclerosing cholangitis with and without hepatic inflammatory pseudotumor, and sclerosing pancreatitis-associated sclerosing cholangitis: do they belong to a spectrum of sclerosing pancreatitis? Am J Surg Pathol. 2004;28:1193–203.
Koea JB, Broadhurst GW, Rodgers MS, McCall JL. Inflammatory pseudotumor of the liver: demographics, diagnosis, and the case for nonoperative management. J Am Coll Surg. 2003;196:226–35.
Yoon KH, Ha HK, Lee JS, et al. Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation. Radiology. 1999;211:373–9.
Sakai T, Shiraki K, Yamamoto N, et al. Diagnosis of inflammatory pseudotumor of the liver. Int J Mol Med. 2002;10:281–5.
Toda K, Yasuda Y, Nishigaki Y, et al. Inflammatory pseudotumor of the liver with primary sclerosing cholangitis. J Gastroenterol. 2000;35:304–9.
Fukuya T, Honda H, Matsumata T, et al. Diagnosis of inflammatory pseudotumor of the liver: value of CT. Am J Roentgenol. 1994;163:1087–91.
Nam KJ, Kang HK, Lim JH. Author’s correction. Inflammatory pseudotumor of the liver: CT and sonographic findings. Am J Roentgenol. 1996;167:1598.
Jais P, Berger JF, Vissuzaine C, et al. Regression of inflammatory pseudotumor of the liver under conservative therapy. Dig Dis Sci. 1995;40:752–6.
Di Vita G, Soresi M, Patti R, et al. Concomitant inflammatory pseudotumor of the liver and spleen. Liver. 2001;21:217–22.
Vassiliadis T, Vougiouklis N, Patsiaoura K, et al. Inflammatory pseudotumor of the liver successfully treated with nonsteroidal anti-inflammatory drugs: a challenge diagnosis for one not so rare entity. Eur J Gastroenterol Hepatol. 2007;19:1016–20.
Yamaguchi J, Sakamoto Y, Sano T, et al. Spontaneous regression of inflammatory pseudotumor of the liver: report of three cases. Surg Today. 2007;37:525–9.
Anthony PP, Tekesinghe PU. Inflammatory pseudotumor of the liver. J Clin Pathol. 1986;39:761–8.
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Ahn, K.S., Kang, K.J., Kim, Y.H. et al. Inflammatory pseudotumors mimicking intrahepatic cholangiocarcinoma of the liver; IgG4-positivity and its clinical significance. J Hepatobiliary Pancreat Sci 19, 405–412 (2012). https://doi.org/10.1007/s00534-011-0436-z
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DOI: https://doi.org/10.1007/s00534-011-0436-z