Inflammatory Pseudotumor of the Liver Masquerading as Hepatocellular Carcinoma After a Hepatitis B Virus Infection: Report of a Case

We report a rare case of hepatic inflammatory pseudotumor (IPT) after a hepatitis B virus (HBV) infection. Early contrast enhancement on computed tomography (CT) with a washout phenomenon at the delayed phase, and depleted Kupffer cell function on superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) suggested hepatocellular carcinoma (HCC). However, the lack of a tumor capsule, absence of liver cirrhosis, and normal serum levels of α-fetoprotein and PIVKA-II (protein induced by vitamin K absence; descarboxyprothrombin) contradicted this diagnosis. We excised the tumor to exclude malignancy, and the histopathological diagnosis was IPT. Recent evidence suggests that this entity has changed from an extremely rare pathology to an established disease. Thus, IPT should be considered in the differential diagnosis of a liver mass with an infectious–inflammatory antecedent. Although surgery is not mandatory, surgical removal is recommended if there is a possibility of malignancy. Further investigations are warranted to elucidate the mechanisms of IPT developing after an HBV infection.     

Inflammatory pseudotumour of the spleen associated with splenic tuberculosis

Inflammatory pseudotumor (IPT) of the spleen is an uncommon entity with an uncertain aetiology. Inflammatory pseudotumors present diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The symptoms include weight loss, fever, and abdominal pain. Most cases of splenic IPT present solitary relatively large well circumscribed masses on imaging. The diagnosis in the majority of the cases is made after histopathologic study of splenectomy specimens. The IPTs that occur in the spleen and liver are typically associated with Epstein-Barr virus. Thirty-seven percent of all new cases of active tuberculosis infection are extrapulmonary tuberculosis and tuberculous lymphadenitis the most commonly occurring form of extrapulmonary tuberculosis. We report the case of an inflammatory pseudotumor of the spleen associated with splenic tuberculous lymphadenitis in a 50-year-old female patient who was preoperatively diagnosed with a malignant spleen tumour based on her history of breast of carcinoma.     

Hepatic Inflammatory Pseudotumor Mimicking Intrahepatic Cholangiocarcinoma: Report of a Case

Hepatic inflammatory pseudotumor (IPT) is a relatively rare lesion comprised of proliferating fibrovascular tissue infiltrated by inflammatory cells. IPT has a potential for recurrence and persistent local growth. We present a case of hepatic IPT mimicking a periductal-infiltrating type of intrahepatic cholangiocarcinoma (ICC) in a patient whose serum carbohydrate antigen 19-9 was slightly elevated. We performed a left hepatic lobectomy with resection of the extrahepatic bile duct and regional lymph node dissection under a preoperative diagnosis of ICC. However, histlogical examination of the resected tumor revealed granuloma tissue with lymphocyte infiltration, mainly by plasma cells, and proliferation into the surrounding connective tissue, and the lesion was ultimately diagnosed as hepatic IPT. This case points out the difficulties in differentiating between hepatic IPT extending along Glisson's sheath and ICC, based on imaging findings alone.     

Inflammatory pseudotumor of the bladder: a new case report

Inflammatory pseudotumor is a reactive benign lesion which can be very difficult to distinguish from some malignant bladder tumors like sarcomas or sarcomatoid carcinoma. Inflammatory pseudotumour (IPT) of the urinary bladder is a benign proliferate lesion which can simulate clinically and histologically a sarcoma. A case of an inflammatory pseudotumor of the urinary bladder in a 18-years-old man is presented. This patient presented with sudden onset of gross painless hematurial related to large polypoid and ulcerated bladder masses found on endoscopy. Initial pathological analysis was interpreted as rhabdomyosarcoma but subsequent reviews were consistent with a benign process resembling nodular fasciitis. This rare, benign and presumed non-neoplastic, reactive lesion must be differentiated from sarcomas of the urinary bladder. Immunohistochemistry seems to be the method of election in differentiating inflammatory pseudo-tumor from other spindle cell proliferations of the bladder. When diagnosis is certain, complete transurethral resection is the treatment of choice. However, if there is no total pathologic confirmation, if it is a very wide lesion or if it is recurring after endoscopic resection, a partial cystectomy is suggested.     

Inflammatory pseudotumor of urinary bladder – a diagnostic and management dilemma

Inflammatory pseudotumors (IPT) are uncommon, benign, non-epithelial tumors of the urinary bladder. Only less than 30 cases have been reported so far in world’s literature. The transititional cell carcinoma constitutes 90% of malignant epithelial tumors of urinary bladder. Large, endoscopically unresectable tumors require radical surgery. IPT resemble such tumors, morphologically, radiologically and clinically. The benign nature of this tumor warrants conservative surgical management, either transurethral resection or partial cystectomy. Awareness of this entity and its inclusion in the differential diagnosis may prevent unnecessary radical surgery. We report an unusual case of inflammatory pseudotumor of urinary bladder because of its diagnostic and management dilemma.     

Multiple Inflammatory Pseudotumor of the Liver,Mimicking Cholangiocarcinoma with Tumor Embolus in the Hepatic Vein: Report of a Case

A 68-year-old Japanese woman complaining of general fatigue and intermittent high fever was admitted to our hospital. Abdominal ultrasonography showed two tumors in the lateral segment of the liver, with soft tissue in the left hepatic vein that was considered to be a tumor embolus. A diagnosis of cholangiocarcinoma was made based on various radiological and laboratory examinations and therefore a surgical resection was performed. Microscopically, the tumor consisted of inflammatory cells, which had aggressively invaded the hepatic vein and Arantius' duct. The pathological diagnosis was inflammatory pseudotumor (IPT) that had invaded the hepatic vein. Although many cases of hepatic IPT have been previously reported, cases of hepatic IPT massively invading the hepatic vein are very rare as far as we could determine, based on a literature search. We herein report this case and discuss the diagnosis and treatment regarding hepatic IPT with massive venous invasion.     

50例肝脏炎性假瘤的临床分析

目的：探讨肝脏炎性假瘤的临床表现，为诊断及治疗提供依据。方法：收集50例经手术和病理证的肝脏炎性假瘤病例资料进行回顾分析。结果：该组平均年龄44岁，男性多见，占68％。50例患者中25例无明显症状，21例有右上腹疼痛，4例出现发热。病灶位于右叶占80％。其中84％患者B超表现为低回声或略低回声，66％边界清楚，72％肿块内部回声不均匀。CT检查示均为低密度影，形态不规则，只有19．4％的患者增强扫描后出现不同时期的增强。17例患者行MRI检查T1加权粉氏信号，不均匀，边缘模糊，质子加权为等信号；T2加权4例等低信号，2例等信号，11例为略高信号，病灶内似有分隔，增强后只有2例轻度强化。50例术后均恢复良好。结论：B超发现肝脏炎性假瘤的重要手段，动态CT扫描及MRI对于鉴别其他肝脏占位有较大帮助。手术切除仍是目前首选的治疗方法。     

Laparoscopic distal pancreatectomy for inflammatory pseudotumor of the pancreas

An 82-year-old woman presented with abdominal pain, nausea, emesis, and weight loss of ~25 lb over 6 months. A CT scan and MRI of the abdomen revealed a mass in the tail of the pancreas that was suspicious for malignancy. The patient underwent successful laparoscopic distal pancreatectomy and was discharged home on the 4th postoperative day after an uneventful course. Pathology revealed an inflammatory pseudotumor of the pancreas (IPT). Pancreatic IPT is a rare entity, and this case represents the first report of laparoscopic resection of this lesion. The presentation, diagnosis, histologic features, and therapy of IPT of the pancreas are reviewed.     

A case report of inflammatory pseudotumor of the lung: rapid recurrence appearing as multiple lung nodules.

An inflammatory pseudotumor (IPT), known as a plasma cell granuloma, is a relatively uncommon neoplasm with an unidentified etiology. To our knowledge, an early relapse with multiple lung nodules following lung resection and occurrences in multiple organs is extremely rare. The patient was a 49-year-old man who presented with left chest pain and fever. A chest film demonstrated an 8x8 cm mass in the left lower lobe. During thoracotomy in April 2001, a mass was seen to have invaded the diaphragm with remarkable pleural adhesion. The intraoperative pathological diagnosis was infiltration of inflammatory cells with no malignancy. Therefore, a partial resection of the left lower lobe was performed. Three months after the thoracotomy, a chest CT scan disclosed multiple nodular opacities bilaterally, and an open lung-biopsy of the right lung was performed in January 2002. His past history included an excision of a mass on the penis in another hospital in 1994 and a subcutaneous mass that appeared on the right thigh and disappeared spontaneously following a needle biopsy in 1999. Pathologically there was no fundamental difference among his present lesion and the former two. The pathological diagnosis at each occurrence was inflammatory pseudotumor (IPT). In immunohistochemical study, the staining with smooth muscle actin cells was positive, but was negative for the staining with anaplastic lymphoma kinase (ALK). With no evidence of a neoplastic process, these histopathological and immunohistochemical findings could imply that this case may be a postinflammatory reparative reaction, although his condition exhibited the clinically aggressive behavior of suspected lung metastasis.     

Inflammatory pseudotumor of the spleen

We report a case of a patient with inflammatory pseudotumor (IPT) of the spleen. IPTs can appear at many sites and represent rear lesions of uncertain etiopathogenesis. Usually they present as mass lesions, so the clinical and radiologic features often suggest malignancy. However, the microscopic findings are quite characteristic, and the diagnosis can be made readily by identifying the reactive nature of the cells. Diagnostic problems can arise when these lesions occur in lymphoid organs or the spleen.     

Inflammatory pseudotumor of the alimentary tract: clinical and surgical experience

BACKGROUND/PURPOSE: Initially described in 1937, inflammatory pseudotumor (IPT) inflammatory myofibroblastic tumor (IMT) or plasma cell granulomas are synonymous for an inflammatory solid tumor that contains spindle cells, myofibroblasts, plasma cells, and histocytes. Common sites of presentation include lung, mesentary, liver, and spleen; intestinal presentations are rare, and the etiology remains obscure. This report details the clinical and surgical experiences in 4 children with alimentary tract IPT at a single institution. METHODS: A retrospective chart review was conducted of pediatric patients with the pathologic diagnosis of IPT. RESULTS: Between 1990 and 1999, 4 patients (4 girls, ages 5 to 15 years) were identified with gastrointestinal tract origins of IPT. Symptoms at presentation included anemia (n = 4), intermittent abdominal pain (n = 3), fever (n = 3), weight loss (n = 2), diarrhea (n = 2), dysphagia (n = 1). Two patients had comorbid conditions of juvenile rheumatoid arthritis and mature B cell lymphoma. Three of 4 patients had elevated sedimentation rates. The sites of origin were the gastroesophageal junction, the colon, the rectum, and the appendix, with the referral diagnosis achalasia, perforated appendix, inflammatory bowel disease, and recurrent lymphoma, respectively. All were treated with aggressive surgical resection, and 3 girls have had no recurrences since the initial surgery. One patient had 3 recurrences within 8 months of presentation; she remains disease free 8 years later. CONCLUSIONS: IPT, although rare in the gastrointestinal tract, mimics more common problems. Successful surgical management is possible even in cases of multiple recurrences.     

儿童输尿管炎性假瘤1例报告并文献复习

目的：探讨输尿管炎性假瘤(1nflammatory pseudotumor，IPT)的临床特点，提高其诊治水平。方法：报告1例9岁男性输尿管IPT患者，并复习文献就相关问题予以讨论。结果：术后患者恢复良好，痊愈出院。病理检查证实为输尿管IPT。结论：IPT指组织炎性增生形成的肿瘤样团块，根据症状、体征及影像学检查结果难与恶性肿瘤相鉴别，其确诊有赖于病理学检查。输尿管IPT治疗大多仍需行外科手术，并在治疗后进行随访。     

Spontaneous Regression of Inflammatory Pseudotumor of the Liver: Report of Three Cases

Inflammatory pseudotumor (IPT) of the liver is a rare benign hepatic lesion that sometimes mimics malignant tumors. An accurate diagnosis of IPT is important to avoid unnecessary surgery. We herein report three cases of IPT of the liver that spontaneously regressed and were successfully diagnosed without a surgical resection. Malignant tumors were initially suspected based on the initial imaging findings, including ultrasonography, computed tomography (CT), and magnetic resonance imaging. In particular, a delayed enhancement in the periphery of the masses was observed on dynamic CT scans, similar to the imaging results for metastatic tumors or intrahepatic cholangiocarcinomas. The serum levels of C-reactive protein were elevated in all three patients (6.6, 3.4, and 1.5 mg/dl), while the serum levels of tumor markers were almost within the normal ranges (carcinoembryonic antigen, <5 ng/ml; carbohydrate antigen 19-9, 201, 3, and 14 U/ml). Serial repeated imaging studies over the course of a month showed the spontaneous regression of the hepatic tumors, thus enabling us to make a diagnosis of IPT without a surgical resection. A percutaneous biopsy confirmed the histology in one case. The regression of tumors on repeated images should play a key role in making an accurate diagnosis of IPT.     

Treatment of pseudotumors with nonsteroidal antiinflammatory drugs

Large inflammatory pseudotumors (IPT) traditionally are managed with extensive surgical resection. This approach, which often is associated with significant morbidity, has been deemed necessary because of the uncertainty of diagnosis, symptomatology, and involvement of vital structures. Also, there is a lack of other reliable therapy for this clinically aggressive yet histologically benign disease characterized by an overreactive inflammatory response. The authors treated 2 cases of abdominal IPT with nonsteroidal antiinflammatory drug (NSAID) with successful results. After a diagnosis of IPT on tumor biopsy, an NSAID trial can confirm the diagnosis and treat the disease by causing tumor shrinkage and eventual resolution. Excision remains indicated in easily resectable tumors and in nonresponders to NSAID therapy.     

Spindle cell tumors associated with mycobacteria in lymph nodes of HIV-positive patients: 'Kaposi sarcoma with mycobacteria' and 'mycobacterial pseudotumor'.

Patients infected with HIV often have unusual manifestations of common infections and neoplasms. One such example is "mycobacterial pseudotumor," an exuberant spindle cell lesion induced in lymph nodes by mycobacteria. Kaposi sarcoma also produces a spindle cell proliferation in lymph nodes of HIV-positive patients. These two entities must be differentiated from one another because of differences in treatment and prognosis. We report here, however, three cases of intranodal Kaposi sarcoma with simultaneous mycobacterial infection, the occurrence of which has not been clearly documented. For comparison, we also studied three cases of mycobacterial pseudotumor, of which 14 cases have been described to date. There was considerable histologic overlap between these two lesions. Acid-fast bacilli were present in all cases, predominantly in the more epithelioid histiocytes in the cases of Kaposi sarcoma, and in spindle and epithelioid cells in the cases of mycobacterial pseudotumor. The morphologic features that favored Kaposi sarcoma over mycobacterial pseudotumor were the prominent fascicular arrangement of spindle cells and slitlike spaces, the lack of granular, acidophilic cytoplasm, and the presence of mitoses. Immunohistochemistry was a reliable adjunct study in the differential diagnosis, as the spindle cells in mycobacterial pseudotumor were positive for S-100 protein and CD68 whereas those of Kaposi sarcoma were CD31- and CD34-positive but negative for S-100 protein and CD68. Awareness that Kaposi sarcoma may coexist with mycobacterial infection in the same biopsy specimen is important because these lesions may be misdiagnosed as mycobacterial pseudotumor. The clinical impact of distinguishing between Kaposi sarcoma with mycobacteria and mycobacterial pseudotumor is significant because the presence of Kaposi sarcoma alters treatment and prognosis.     

Inflammatory pseudotumor of the liver and the spleen

Inflammatory pseudotumor is rare benign lesion ad uncommon is a multiple localization of the liver and spleen. We report a case of inflammatory pseudotumor of the liver associated with an other lesion in the spleen, a 53-years-old ma in which we observed the evolution of clinical picture. Making the diagnosis is often difficult, despite the use of the modern imaging and laboratories techniques, and generally these masses often confuse with others lesions, such as primary or secondary neoplasm, because the clinical presentation and morphological appearance are often unspecific. The medical treatment seems to be more appropriate for patients when it is possible make a correct diagnosis with a biopsy of the lesion. In the other cases, the surgical procedure is the best treatment that must be supported by histologic examination.     

Inflammatory pseudotumor of the breast in a patient with a high serum IgG4 level: histologic similarity to sclerosing pancreatitis

The association between IgG4 and inflammatory pseudotumor was first reported with regard to pancreatic pseudotumor, which is well known as sclerosing pancreatitis or autoimmune pancreatitis. In addition, there is increasing evidence that IgG4 is also involved in inflammatory pseudotumor of the extrapancreatic tissue. In this report, we present a case of IgG4-related inflammatory pseudotumor of the breast. A 46-year-old woman presented with an induration in the left breast. Radiologic examination revealed an ill-circumscribed mass measuring 1.6 cm in diameter in the left breast. Breast cancer could not be ruled out radiologically, and excision biopsy was performed for a definite diagnosis. Histologically, this nodule was composed of an irregular proliferation of stromal cells associated with severe lymphoplasmacytic infiltration, obliterative phlebitis, and eosinophils. No atypical feature regarding the stromal cells or lymphocytes was observed. Furthermore, many plasma cells within the lesion were immunohistochemically positive for IgG4, and the serum IgG4 concentration of this patient was elevated on postoperative examination. This case suggests that inflammatory pseudotumor of the breast has a pathogenetic process similar to that of sclerosing pancreatitis. IgG4 might become a useful marker for inflammatory pseudotumor of the breast, and it might benefit from steroid therapy, as does sclerosing pancreatitis.     

Inflammatory pseudotumor presenting as a cystic tumor of the pancreas

Inflammatory pseudotumor (IPT) of the pancreas occurs rarely. Eighteen cases have been described in the English literature. In all previous patients IPT of the pancreas presented as solid pancreatic mass. We are reporting a case of IPT presenting as a cystic mass of the pancreas, which has not been described previously. A review of IPT of the pancreas and a discussion regarding the management of pancreatic cystic neoplasm is provided.     

Seudotumor inflamatorio y tumor miofibroblástico inflamatorio. Criterios diagnósticos y diferencias pronósticas

IntroductionInflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules.MethodsThirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis.ResultsOf the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didńt find any loco-regional or distant recurrence in the patients studied.ConclusionIPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.     

Inflammatory pseudotumor of the trachea

Primary tracheal tumors are extremely rare, and the majority of them are malignant. Inflammatory pseudotumor is a benign, tumorlike lesion, most likely of a reactive nature. Its basic morphologic characteristic is spindle cell (myoblasts and fibroblasts) proliferation with a variable number and type of inflammatory cells. A case of intratracheal inflammatory pseudotumor in a 14-year-old boy is presented together with a review of all similar lesions in the available literature. The discussion includes the presentation of tracheal tumors, their basic morphologic and immunohistochemical characteristics, and treatment modalities that are available. The surgeon must exercise caution not to perform radical surgery based on the initial pathologic diagnosis from the intraoperative frozen section, because the prognosis of these benign lesions generally is excellent. This is the second reported case of intratracheal inflammatory pseudotumor successfully endoscopically vaporized using a CO(2) laser, which is an excellent alternative in cases in which surgical treatment is feasible. J Pediatr Surg 36:631-634.