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 alpha-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.
Akatsu
Tomotaka
T
Departments of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.
Wakabayashi
Go
G
Tanimoto
Akihiro
A
Kameyama
Kaori
K
Kitajima
Masaki
M
D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006104:Granuloma, Plasma Cell / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006498:Hepatectomy; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed