Spontaneous Resolution of Multiple Hepatic Masses: Hepatic Inflammatory Pseuduotumor
Xingshun Qi
, Lei Han**, Ankur Arora***, Yue Hou*, Ran Wang*, Sha Chang*, Xiaozhong Guo*
,
Corresponding author
* Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, China
** Department of Hepatobiliary Surgery, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, China
*** Department of Radiology, Worthing Hospital, Western Sussex NHS Foundation Trust, West Sussex, UK
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Hepatobiliary Surgery, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, China" "etiqueta" => "**" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Department of Radiology, Worthing Hospital, Western Sussex NHS Foundation Trust, West Sussex, UK" "etiqueta" => "***" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request:" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1094 "Ancho" => 2074 "Tamanyo" => 248831 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Contrast enhanced CT and MRI images of the liver.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Case Presentation</span><p id="p0010" class="elsevierStylePara elsevierViewall">A previously healthy 59-year-old female presented with intermittent fever for 4 days. The highest temperature was 40 °C. Buluofen was given at home, but fever relapsed. She denied any history of liver diseases. She did not smoke or have any history of alcohol or drug abuse. On physical examinations, there were no positive signs. At our admission, abnormal laboratory tests (2016-12-19) were primarily shown as follows: white blood cell was 12.3 x 10<span class="elsevierStyleSup">9</span>/L (reference range: 3.5-9.5 x 10<span class="elsevierStyleSup">9</span>/L), percentage of neu-trophil was 81.9% (reference range: 40-75%), C reactive protein was 99.4 mg/L (reference range: 0-8 mg/L), procal-citonin was 0.378 ng/mL (reference range: 0-0.05 ng/mL), total bilirubin was 48.88 umol/L (reference range: 5.1-22.2 umol/L), direct bilirubin was 17.2 umol/L (reference range: 0-8.6 umol/L), aspartate aminotransferase was 111.68 U/L (reference range: 13-35 U/L), alanine ami-notransferase was 181.88 (reference range: 7-40 U/L), alkaline phosphatase was 154.83 U/L (reference range: 35-135 U/L), gamma-glutamyl transferase was 164.91 U/L (reference range: 7-45 U/L), albumin was 38.2 g/L (reference range: 40-55 g/L), mycoplasma pneumoniae antibody IgM was weakly positive, and anti-influenza virus antibody IgM was weakly positive. Viral hepatitis A, B, C, and E were excluded. Alfa-fetal protein, carcinoembryonic antigen, CA50, CA125, CA153, CA199, and CA242 levels were within the normal range. HIV was negative. Creatinine and prothrombin time were within the normal range. Antinu-clear antibody, anti mitochondrial antibody, anti mito-chondrial antibody type M2, and anti smooth muscle antibody were negative. IgG4 test was not available. Intravenous infusion of antibiotics and hepato-protective drugs was given. Six days after treatment, the symptoms gradually disappeared. Thus, blood culture was not performed. Laboratory tests (2016-12-25) were primarily shown as follows: white blood cell was 9.5 x 10<span class="elsevierStyleSup">9</span>/L, percentage of neu-trophil was 68.1%, total bilirubin was 11.4 umol/L, direct bilirubin was 5.3 umol/L, aspartate aminotransferase was 13.3 U/L, alanine aminotransferase was 51.01 U/L, alkaline phosphatase was 217.21 U/L, and gamma-glutamyl trans-ferase was 175.26 U/L. Notably, computed tomography (CT) scans showed multiple low density lesions on the liver, some of them exhibiting a “bulls eye” sign (<a class="elsevierStyleCrossRef" href="#f0010">Figure 1</a>). Hepatic metastatic malignancy was suspected. A positron emission tomography-computed tomography (PET-CT) scan was further performed, which showed that the lesions were highly metabolic. Hepatic epithelioid heman-gioendothelioma was suspected. Finally, a targeted liver biopsy under ultrasound guidance was performed, which excluded malignancy. Because the diagnosis was unclear, no active anti-tumor treatment or surgery was planned. Follow-up magnetic resonance imaging (MRI) surprisingly revealed no hepatic masses (<a class="elsevierStyleCrossRef" href="#f0010">Figure 1</a>). About one month later, another MRI was performed, which confirmed a normal liver again (<a class="elsevierStyleCrossRef" href="#f0010">Figure 1</a>). Based on the history, clinical presentations, and imaging findings, a diagnosis of hepatic inflammatory pseuduotumor was considered. Now, she is keeping well without any other complaints. Laboratory tests (2017-2-25) were primarily shown as follows: white blood cell was 5.5 x 10<span class="elsevierStyleSup">9</span>/L, percentage of neu-trophil was 43.4%, total bilirubin was 10.5 umol/L, direct bilirubin was 3.3 umol/L, aspartate aminotransferase was 32.57 U/L, alanine aminotransferase was 38.54 U/L, alkaline phosphatase was 95.96 U/L, and gamma-glutamyl transferase was 51.39 U/L.</p><elsevierMultimedia ident="f0010"></elsevierMultimedia></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Discussion</span><p id="p0015" class="elsevierStylePara elsevierViewall">Hepatic inflammatory pseuduotumor is a rare disease, including inflammatory myofibroblastic tumor, inflammatory fibrosarcoma, and plasma cell granuloma. Inflammatory pseudotumor of the liver was firstly described by Pack,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> which was characterized by dominant spindle cell proliferation with varying inflammatory components.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">2,3</span></a> The etiology of hepatic inflammatory pseuduotumor remains unclear.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">3,4</span></a> It may be caused by infection, autoimmune conditions, trauma, and surgical inflammation.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">5,6</span></a> Abdominal pain is the most common symptom.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">7</span></a> Other symptoms include fever and malaise. Some cases are asymptomatic. Hepatic inflammatory pseuduotumor is more frequently seen in Asia and is more common in men.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a> Imaging findings are often non-specific and are sometime misinterpreted as malignancy. Liver biopsy can be helpful in clinching the diagnosis. Surgery may be preferable, especially in patients with low surgical risk.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a> Only a small proportion of patients suffer from the recurrence or metastasis after partial hepatectomy.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8,9</span></a> Observation or conservative therapy is an alternative.</p><p id="p0020" class="elsevierStylePara elsevierViewall">In conclusion, we report a female patient with multiple hepatic inflammatory pseuduotumors which resolved spontaneously. Because definitive diagnostic criteria remain unavailable, our case underwent CT, PET-CT, MRI, and liver biopsy to exclude malignancy. A close follow-up observation remains crucial. Lastly, a wait-and-see strategy may be appropriate if a hepatic inflammatory pseudotu-mor liver is diagnosed.</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Conflict of Interest</span><p id="p0025" class="elsevierStylePara elsevierViewall">None.</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Funding</span><p id="p0030" class="elsevierStylePara elsevierViewall">None.</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Author Contributions</span><p id="p0035" class="elsevierStylePara elsevierViewall">Xingshun Qi, Yue Hou, Sha Chang, Xiaozhong Guo: treated, cared, and followed the case.</p><p id="p0040" class="elsevierStylePara elsevierViewall">Xingshun Qi, Lei Han, Ankur Arora: discussed the case and interpreted the images.</p><p id="p0045" class="elsevierStylePara elsevierViewall">Xingshun Qi, Ran Wang: reviewed the literature and drafted the manuscript.</p><p id="p0050" class="elsevierStylePara elsevierViewall">All authors have made an intellectual contribution to the manuscript and approved the submission.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "s0010" "titulo" => "Case Presentation" ] 1 => array:2 [ "identificador" => "s0015" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "s0020" "titulo" => "Conflict of Interest" ] 3 => array:2 [ "identificador" => "s0025" "titulo" => "Funding" ] 4 => array:2 [ "identificador" => "s0030" "titulo" => "Author Contributions" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-03" "fechaAceptado" => "2016-10-03" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1094 "Ancho" => 2074 "Tamanyo" => 248831 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Contrast enhanced CT and MRI images of the liver.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0010" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 10 | 1 | 11 |
| 2024 September | 14 | 1 | 15 |
| 2024 August | 23 | 3 | 26 |
| 2024 July | 12 | 2 | 14 |
| 2024 June | 7 | 3 | 10 |
| 2024 May | 15 | 3 | 18 |
| 2024 April | 10 | 4 | 14 |
| 2024 March | 12 | 2 | 14 |
| 2024 February | 8 | 6 | 14 |
| 2024 January | 4 | 3 | 7 |
| 2023 December | 7 | 4 | 11 |
| 2023 November | 13 | 3 | 16 |
| 2023 October | 13 | 4 | 17 |
| 2023 September | 8 | 2 | 10 |
| 2023 August | 8 | 1 | 9 |
| 2023 July | 6 | 3 | 9 |
| 2023 June | 18 | 2 | 20 |
| 2023 May | 24 | 1 | 25 |
| 2023 April | 36 | 1 | 37 |
| 2023 March | 16 | 4 | 20 |
| 2023 February | 9 | 1 | 10 |
| 2023 January | 4 | 2 | 6 |
| 2022 December | 7 | 4 | 11 |
| 2022 November | 39 | 5 | 44 |
| 2022 October | 16 | 5 | 21 |
| 2022 September | 7 | 6 | 13 |
| 2022 August | 6 | 5 | 11 |
| 2022 July | 12 | 7 | 19 |
| 2022 June | 3 | 6 | 9 |
| 2022 May | 6 | 7 | 13 |
| 2022 April | 7 | 13 | 20 |
| 2022 March | 18 | 10 | 28 |
| 2022 February | 5 | 5 | 10 |
| 2022 January | 14 | 6 | 20 |
| 2021 December | 5 | 11 | 16 |
| 2021 November | 4 | 7 | 11 |
| 2021 October | 7 | 7 | 14 |
| 2021 September | 8 | 6 | 14 |
| 2021 August | 6 | 8 | 14 |
| 2021 July | 7 | 8 | 15 |
| 2021 June | 6 | 7 | 13 |
| 2021 May | 9 | 5 | 14 |
| 2021 April | 19 | 16 | 35 |
| 2021 March | 7 | 9 | 16 |
| 2021 February | 8 | 6 | 14 |
| 2021 January | 4 | 10 | 14 |
| 2020 December | 4 | 4 | 8 |
| 2020 November | 2 | 1 | 3 |
| 2020 October | 6 | 5 | 11 |
| 2020 September | 6 | 8 | 14 |
| 2020 August | 5 | 3 | 8 |
| 2020 July | 6 | 5 | 11 |
| 2020 June | 2 | 3 | 5 |
| 2020 May | 8 | 6 | 14 |
| 2020 April | 6 | 3 | 9 |
| 2020 March | 1 | 1 | 2 |
| 2020 February | 7 | 6 | 13 |
| 2020 January | 7 | 0 | 7 |
| 2019 December | 7 | 3 | 10 |
| 2019 November | 3 | 5 | 8 |
| 2019 October | 1 | 1 | 2 |
| 2019 September | 1 | 0 | 1 |
| 2019 August | 1 | 0 | 1 |
| 2019 July | 4 | 6 | 10 |
| 2019 June | 0 | 1 | 1 |
| 2019 May | 1 | 5 | 6 |
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