Hepatic inflammatory pseudotumor with elevated serum CA19-9 level mimicking liver metastasis from rectal cancer: report of a case.
Inflammatory pseudotumor (IPT) of the liver is rare, and differential diagnosis from malignant tumors is difficult. We herein report a case of IPT of the liver with marked elevation of carbohydrate antigen 19-9 (CA19-9). A 72-year-old woman, who underwent low anterior resection for rectal cancer, had low-grade fever and epigastric pain. The patient has well-controlled idiopathic thrombocytopenic purpura (ITP) with steroid maintenance treatment. Abnormal laboratory findings included serum carcinoembryonic antigen of 15.9 ng/mL and CA19-9 up to 14,632 U/mL. Computed tomography revealed a low-density lesion, and magnetic resonance imaging demonstrated a high intensity lesion on T1, T2-weighted, and diffusion-weighted images (55 × 22 mm in the Couinaud's segment 4 of the liver). However, 1 month after the appearance of the symptom, serum level of CA19-9 suddenly decreased to 37 U/mL. The tumor decreased spontaneously to 20 × 10 mm. Seven months later, the tumor had reduced to 18 × 11 mm. With a diagnosis of IPT, the patient remains well without regrowth of the tumor at 1 year follow-up after CA19-9 decrease to normal limits.
Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Yoshihiro
Y
Shirai
Hiroaki
H
Shiba
Yuki
Y
Fujiwara
Ken
K
Eto
Takeyuki
T
Misawa
Katsuhiko
K
Yanaga
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006104:Granuloma, Plasma Cell / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery
D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen