Euroasian Journal of Hepato-Gastroenterology

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VOLUME 9 , ISSUE 2 ( July-December, 2019 ) > List of Articles

CASE REPORT

An Enigmatic Liver Mass in a Child

Ravi Thanage, Nikhil Sonthalia, Sanjay Chandnani

Keywords : Inflammatory pseudotumor, Liver abscess,Corticosteroids

Citation Information : Thanage R, Sonthalia N, Chandnani S. An Enigmatic Liver Mass in a Child. Euroasian J Hepatogastroenterol 2019; 9 (2):104-107.

DOI: 10.5005/jp-journals-10018-1307

License: CC BY-NC 4.0

Published Online: 00-12-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Hepatic space occupying lesions in childhood are a diagnostic challenge, as they are caused by a variety of malignant and nonmalignant disorders with a different prognosis and, of course, treatment. They are often misdiagnosed or diagnosed only after surgical resection. A 14-year-old boy presented with abdominal pain, evening-rise fever with loss of appetite and weight. The patient also developed jaundice after 2 months of above symptoms. Ultrasound of the abdomen showed an irregular infiltrative mass in segment IV of the liver. Gadobenate disodium magnetic resonance imaging done showed T1 hypointense and T2 hyperintense lesions in segment VIII of the liver with extension into porta with delayed enhancement suggestive of fibrous tumor. Liver biopsy showed extensive liver parenchymal fibrosis with a mixed inflammatory infiltrate with eosinophils. Bacterial, tubercular, and fungal culture of liver biopsy were negative. Although serum IgG4 levels were 7.88 g/L (N =1.9 g/L), IgG4 staining of liver biopsy was negative. The patient was started on prednisolone 1 mg/kg considering the diagnosis of inflammatory pseudotumor (IPT). Twenty days after starting the steroid, mass lesions were converted into multicystic abscess requiring antibiotics and pigtail drainage. On follow-up, patient had improved symptoms with mass lesions turned into small-sized abscess cavity. Hepatic IPTs are difficult to differentiate from malignant tumors, as they are rare and can have variable imaging findings. To avoid inadvertent surgery, histological confirmation of the hepatic mass is essential. Steroids should be used with caution with close follow-up to prevent iatrogenic complications, such as a chronic liver abscess.


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  1. Torzilli G, Inoue K, Midorikawa Y, et al. Inflammatory pseudotumors of the liver: prevalence and clinical impact in surgical patients. Hepatogastroenterology 2001;48(40):1118–1123.
  2. Horiuchi R, Uchida T, Kojima T, et al. Inflammatory pseudo- tumor of the liver. Clinicopathologic study and review of the literature. Cancer 1990;65(7):1583–1590. DOI: 10.1002/1097-0142 (19900401)65:7<1583::AID-CNCR2820650722>3.0.CO;2-L.
  3. Coffin CM, Humphrey PA, Dehner LP. Extrapulmonary inflammatory myofibroblastictumor: a clinical and pathological survey. Semin Diagn Pathol 1998;15(2):85–101.
  4. Melloni G, Carretta A, Ciriaco P, et al. Inflammatory pseudotumor of the lung in adults. Ann Thorac Surg 2005;79(2):426–432. DOI: 10.1016/j.athoracsur.2004.07.077.
  5. Kawaguchi T, Mochizuki K, Kizu T, et al. Inflammatory pseudotumor of the liver and spleen diagnosed by percutaneous needle biopsy. World J Gastroenterol 2012;18(1):90–95. DOI: 10.3748/wjg.v18.i1.90.
  6. White JE, Chase CW, Kelley JE, et al. Inflammatory pseudotumor of the liver associated with extrahepatic infection. South Med J 1997;90(1):23–29. DOI: 10.1097/00007611-199701000-00005.
  7. Yamamoto H, Yamaguchi H, Aishima S, et al. Inflammatory myofibroblastictumor versus IgG4-related sclerosing disease and inflammatory pseudotumor: a comparative clinicopathologic study. Am J Surg Pathol 2009;33(9):1330–1340. DOI: 10.1097/PAS.0b013e3181a5a207.
  8. Zen Y, Fujii T, Sato Y, et al. Pathological classification of hepatic inflammatory pseudotumor with respect to IgG4-related disease. Mod Pathol 2007;20(8):884–894. DOI: 10.1038/modpathol.3800836.
  9. Nakanuma Y, Tsuneyama K, Masuda S, et al. Hepatic inflammatory pseudotumor associated with chronic cholangitis: report of three cases. Hum Pathol 1994;25(1):86–91. DOI: 10.1016/0046-8177(94)90176-7.
  10. Yoon KH, Ha HK, Lee JS, et al. Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation. Radiology 1999;211(2):373–379. DOI: 10.1148/radiology.211.2.r99ma36373.
  11. Kitajima K, Shiba H, Nojiri T, et al. Intrahepatic cholangiocarcinoma mimicking hepatic inflammatory pseudotumor. J Gastrointest Surg 2007;11(3):398–402. DOI: 10.1007/s11605-006-0071-1.
  12. Ishida H, Tatsuta M, Furukawa H, et al. Multiple inflammatory pseudotumors mimicking liver metastasis from colon cancer: report of a case. Surg Today 2000;30(6):530–533. DOI: 10.1007/s005950070121.
  13. Fukuya T, Honda H, Matsumata T, et al. Diagnosis of inflammatory pseudotumor of the liver: value of CT. AJR Am J Roentgenol 1994;163(5):1087–1091. DOI: 10.2214/ajr.163.5.7976880.
  14. Pack GT, Baker HW. Total right hepatectomy; report of a case. Ann Surg 1953;138(2):253–258. DOI: 10.1097/00000658-195308000-00012.
  15. Nagarajan S, Jayabose S, McBride W, et al. Inflammatory myofibroblastictumor of the liver in children. J Pediatr Gastroenterol Nutr 2013;57(3):277–280. DOI: 10.1097/MPG.0b013e31829e0b3b.
  16. Al-Hussaini H, Azouz H, Abu-Zaid A. Hepatic inflammatory pseudotumor presenting in an 8-year-old boy: a case report and review of literature. World J Gastroenterol 2015;21(28):8730–8738. DOI: 10.3748/wjg.v21.i28.8730.
  17. Patnana M, Sevrukov AB, Elsayes KM, et al. Inflammatory pseudotumor: the great mimicker. AJR Am J Roentgenol 2012;198(3):217–227. DOI: 10.2214/AJR.11.7288.
  18. Zen Y, Harada K, Sasaki M, et al. IgG4-related sclerosing cholangitis with and without hepatic inflammatory pseudotumor, and sclerosing pancreatitis-associated sclerosing cholangitis: do they belong to a spectrum of sclerosing pancreatitis? Am J Surg Pathol 2004;28(9):1193–1203. DOI: 10.1097/01.pas.0000136449.37936.6c.
  19. Shibata M, Matsubayashi H, Aramaki T, et al. A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment. BMC Gastroenterol 2016;16(1):89. DOI: 10.1186/s12876-016-0504-6.
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