title: Hepatic inflammatory pseudotumor presenting in an 8-year-old boy: A case report and review of literature.
abstract: Hepatic inflammatory pseudotumors are uncommon benign lesions. Accurately diagnosing hepatic inflammatory pseudotumor can be very challenging because the clinical presentation and radiological appearances are nonspecific and cannot be certainly distinguished from malignant neoplastic processes. Herein, we present a case of hepatic IPT in an 8-year-old boy who presented to clinic with a 3-mo history of a tender hepatic mass, fever of unknown origin, and 9-kg weight loss. The physical examination was notable for tender hepatomegaly. Laboratory investigations were notable for a normal hepatic profile and elevated erythrocyte sedimentation rate and C-reactive protein. A T2-attenuated magnetic resonance imaging scan of the abdomen showed a 4.7 cm × 4.7 cm × 6.6 cm, contrast-enhancing, hyper-intense, well-defined lesion involving the right hepatic lobe. In view of the unremitting symptoms, tender hepatomegaly, thrombosed right hepatic vein, nonspecific radiological findings, and high suspicion of a deep-seated underlying infection or malignancy, a right hepatic lobectomy was recommended. Microscopically, the hepatic lesion exhibited a mixture of inflammatory cells (histiocytes, plasma cells, mature lymphocytes, and occasional multinucleated giant cells) in a background of dense fibrous tissue. Immunohistochemically, the cells stained negative for SMA, ALK-1, CD-21 and CD-23, diffusely positive for CD-68, and focally positive for IgG4. The final histopathological diagnosis was consistent with hepatic IPT. At the postoperative 4-mo follow-up, the patient was asymptomatic without radiological evidence of recurrence.
authors.affiliation: Hussa Al-Hussaini, Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia.
authors.forename: Hussa
authors.initials: H
authors.lastname: Al-Hussaini
authors.affiliation: Hussa Al-Hussaini, Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia.
authors.forename: Haya
authors.initials: H
authors.lastname: Azouz
authors.affiliation: Hussa Al-Hussaini, Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abu-Zaid
mesh_terms: D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D002648:Child; D006104:Granuloma, Plasma Cell / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D007150:Immunohistochemistry; D008107:Liver Diseases / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: Hepatic; Inflammatory myofibroblastic tumor; Inflammatory pseudotumor; Liver