Spontaneous Regression of an Inflammatory Pseudotumor of the Liver

Zusammenfassung

Inflammatorische Pseudotumoren (IPT) wurden für fast alle Organe und Gewebe beschrieben, finden sich aber nur selten in der Leber. Klinisch präsentieren sich die Patienten in der Regel mit Fieber, Abgeschlagenheit, Gewichtsverlust und oft mit einer Raumforderung im Oberbauch. Die bildgebenden Verfahren allein erlauben in der Regel keine sichere Diagnose, insbesondere die Abgrenzung zu Neoplasien ist schwierig. Prinzipiell ist eine Biopsie zur Diagnosesicherung unumgänglich. Der klinische Verlauf ist meist benigne, allerdings sind aggressive Verlaufsformen bekannt. Bei einem Großteil der beschriebenen Patienten wurde eine Resektion vorgenommen oder die Patienten wurden medikamentös behandelt. Wir schildern eine Patientin mit histologisch gesichertem IPT der Leber, bei der der IPT sich über einige Monate spontan und ohne spezifische Therapie zurückentwickelte.

Abstract

Inflammatory pseudotumors (IPT) have been described for virtually every site in the body but is rare in the liver. The clinical presentation of hepatic IPT is unspecific, patients complain of fever, malaise, weight loss and often of symptoms related to a mass effect. Routine imaging procedures are not sufficient to make the diagnosis and a biopsy is necessary to differentiate IPT from neoplasms. The course of the disease is unpredictable and in most of the reported cases the patients underwent resection or were medically treated. We report a patient with a histologically proven IPT of the liver that regressed spontaneously over several months without any specific treatment.

Schlüsselwörter

Inflammatorischer Pseudotumor - Lebertumor

Key words

Inflammatory pseudotumor - liver tumor

References

• 1 Zavaglia C, Barberis M, Gelosa F. et al . Inflammatory pseudotumour of the liver with malignant transformation. Report of two cases.  Ital J Gastroenterol. 1996;  28 152-159
• 2 Voss S D, Kruskal J B, Kane R A. Chronic inflammatory pseudotumor arising in the hepatobiliary-pancreatic system: progressive multisystemic organ involvement in four patients.  AJR Am J Roentgenol. 1999;  173 1049-1054
• 3 Coffin C M, Humphrey P A, Dehner L P. Extrapulmonary inflammatory myofibroblastic tumor: a clinical and pathological survey.  Semin Diagn Pathol. 1998;  15 85-101
• 4 Trotter J F, Everson G T. Benign focal lesions of the liver.  Clin Liver Dis. 2001;  5 17-42
• 5 Gollapudi P, Chejfec G, Zarling E J. Spontaneous regression of hepatic pseudotumor.  Am J Gastroenterol. 1992;  87 214-217
• 6 Anthony P P, Telesinghe P U. Inflammatory pseudotumour of the liver.  J Clin Pathol. 1986;  39 761-768
• 7 Ishida H, Tatsuta M, Furukawa H. et al . Multiple inflammatory pseudotumors mimicking liver metastasis from colon cancer: report of a case.  Surg Today. 2000;  30 530-533
• 8 Fukuya T, Honda H, Matsumata T. et al . Diagnosis of inflammatory pseudotumor of the liver: value of CT.  AJR Am J Roentgenol. 1994;  163 1087-1091
• 9 Abehsera M, Vilgrain V, Belghiti J. et al . Inflammatory pseudotumor of the liver: radiologic-pathologic correlation.  J Comput Assist Tomogr. 1995;  19 80-83
• 10 Flisak M E, Budris D M, Olson M C. et al . Inflammatory pseudotumor of the liver: appearance on MRI.  Clin Imaging. 1994;  18 1-3
• 11 Nakanuma Y, Tsuneyama K, Masuda S. et al . Hepatic inflammatory pseudotumor associated with chronic cholangitis: report of three cases.  Hum Pathol. 1994;  25 86-91
• 12 Shek T W, Ng I O, Chan K W. Inflammatory pseudotumor of the liver. Report of four cases and review of the literature.  Am J Surg Pathol. 1993;  17 231-238
• 13 Broughan T A, Fischer W L, Tuthill R J. Vascular invasion by hepatic inflammatory pseudotumor. A clinicopathologic study.  Cancer. 1993;  71 2934-2940
• 14 Arber D A, Weiss L M, Chang K L. Detection of Epstein-Barr Virus in inflammatory pseudotumor.  Semin Diagn Pathol. 1998;  15 155-160
• 15 Cheuk W, Chan J K, Shek T W. et al . Inflammatory pseudotumor-like follicular dendritic cell tumor: a distinctive low-grade malignant intra-abdominal neoplasm with consistent Epstein-Barr virus association.  Am J Surg Pathol. 2001;  25 721-731
• 16 Selves J, Meggetto F, Brousset P. et al . Inflammatory pseudotumor of the liver. Evidence for follicular dendritic reticulum cell proliferation associated with clonal Epstein-Barr virus.  Am J Surg Pathol. 1996;  20 747-753
• 17 Tai Y S, Lin P W, Chen S G. et al . Inflammatory pseudotumor of the liver in a patient with human immunodeficiency virus infection.  Hepatogastroenterology. 1998;  45 1760-1763
• 18 Amankonah T D, Strom C B, Vierling J M. et al . Inflammatory pseudotumor of the liver as the first manifestation of Crohns disease.  Am J Gastroenterol. 2001;  96 2520-2522
• 19 Takahashi T, Haneda T, Nagano T. et al . Inflammatory pseudotumor of the liver complicated with recurrent gouty arthritis.  Intern Med. 2001;  40 493-498
• 20 Yoon K H, Ha H K, Lee J S. et al . Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation.  Radiology. 1999;  211 373-379
• 21 Jafri S Z, Bree R L, Agha F P. et al . Inflammatory pseudotumor from sclerosing cholangitis.  J Comput Assist Tomogr. 1983;  7 902-904
• 22 Gough J, Chakrabarti S. Inflammatory pseudotumor of the liver in a patient with chronic sclerosing cholangitis.  Am J Gastroenterol. 1993;  88 1452-1453
• 23 Toda K, Yasuda I, Nishigaki Y. et al . Inflammatory pseudotumor of the liver with primary sclerosing cholangitis.  J Gastroenterol. 2000;  35 304-309
• 24 Schwarz R E, Reynolds J C, Lotze M T. ”Pseudo-pseudotumor” of the liver. Adenocarcinoma presenting as an inflammatory pseudotumor.  Dig Dis Sci. 1994;  39 2679-2684
• 25 Hayashi T, Honda H, Kaneko K. et al . Hepatocellular carcinoma with pyrexia: report of a case.  Radiat Med. 1995;  13 133-136
• 26 Ratziu V, Giral P, Charlotte F. et al . Liver fibrosis in overweight patients.  Gastroenterology. 2000;  118 1117-1123
• 27 Schmid A, Janig D, Bohuszlavizki A. et al . Inflammatory pseudotumor of the liver presenting as incidentaloma: report of a case and review of the literature.  Hepatogastroenterology. 1996;  43 1009-1014
• 28 Noi I, Loberant N, Cohen I. Inflammatory pseudotumor of the liver.  Clin Imaging. 1994;  18 283-285
• 29 Jais P, Berger J F, Vissuzaine C. et al . Regression of inflammatory pseudotumor of the liver under conservative therapy.  Dig Dis Sci. 1995;  40 752-756
• 30 Zamir D, Jarchowsky J, Singer C. et al . Inflammatory pseudotumor of the liver - a rare entity and a diagnostic challenge.  Am J Gastroenterol. 1998;  93 1538-1540
• 31 Li G H, Li J Q, Lin Y Z. Inflammatory pseudotumor of the liver.  J Surg Oncol. 1989;  42 244-248
• 32 Mangiante G L, Colombari R, Portuese A. et al . Inflammatory pseudotumor of the liver: case report and review of the literature.  G Chir. 1997;  18 417-420