[Inflammatory pseudotumor of the liver. Case report of a rare differential diagnosis of hepatocellular carcinoma].
A 46-year old man suffered from fever, sweating, vomiting, abdominal pains, and watery diarrhea during two weeks. The abdomen was tender on pressure. Laboratory findings revealed increased leucocytes to 18,500/microliters, increased thrombocytes to 513,000/microliters, an increased sedimentation rate of 105/129 mm, CRP of 18.2 mg/dl and slightly elevated activities of the amino-transferases. Ultrasonography showed a tumor of the liver with a diameter of 10 cm and a echocomplex wheel-spoke structure. The tumor was confirmed by computed tomography, nuclear resonance tomography, angiography, and scintigraphy without signs of malignity. Fine needle biopsy was negative. Bisegment resection of the liver revealed a tumor of the liver with focal necrosis, with the histological aspect of fibrous tissue with lymphoid infiltration and multiple abscesses. The diagnosis was "inflammatory pseudotumor of the liver" (IPT). Postoperatively the follow-up half a year later was normal. The IPT ist an important differential diagnosis of the hepatocellular carcinoma. The review of 80 cases shows that operative resection of the tumor is the treatment of choice, because the benign diagnosis cannot maintained without doubts. But the pathognomonic trias of symptoms 1. Inflammatory signs, 2. solid tumor of the liver, 3. normal liver tissue allows to make this exceptional diagnosis. The question is whether the operation of the tumor can be avoided by conservative medical therapy.
Strohm
W D
WD
Medizinische Klinik II, Städtisches Krankenhaus Heilbronn.
Stähle
K S
KS
Schumm
G
G
D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006104:Granuloma, Plasma Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged
Inflammatorischer Pseudotumor der Leber. Fallbericht über die seltene Differentialdiagnose des hepatozellulären Karzinoms.