Hepatic inflammatory pseudotumor in a cirrhotic patient

A 40-year-old male with liver cirrhosis was admitted to our department due to recurrent haematemesis and melena for 7 days. He had a 10-year history of hepatitis B virus infection. Alcohol abuse was denied. During his hospitalization, except for blood transfusion, he received intravenous infusion of somatostatin and endoscopic variceal ligation and glue injection for treatment of variceal bleeding. Contrast-enhanced magnetic resonance imaging showed multiple lesions in the liver (Panel A). Tumor markers were within the normal range (alfa-feto protein was 1.35 IU/mL, alfa-feto protein L3 was 0.01 ng/mL, carcinoembryonic antigen was 3.38 ng/mL, carbohydrate antigen 199 was 21.11 U/mL). Liver biopsy was refused. No anti-cancer therapy was initiated. Three months later, endoscopic glue injection was prophylactically performed. Contrast-enhanced computed tomography scans were repeated showing a complete disappearance of hepatic lesions (Panel B). Hepatic inflammatory pseudotumor was considered. He had been followed for 27 months. Now, he is stable without any complaints.

Hepatic inflammatory pseudotumor is a rare benign liver disease, which is characterized as spontaneous resolution of liver lesions without any intervention (1). In the present case with a previous history of hepatitis B virus related liver cirrhosis, multiple liver lesions are readily misdiagnosed as liver malignancy. It is very important for such a case to conduct a short-term follow-up to evaluate whether the liver lesions will spontaneously disappear.

Acknowledgements

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, AME Medical Journal for the cloumn “Images in Clinical Medicine”. The article has undergone external peer review.

Conflicts of Interest: The authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/amj.2018.03.10). The column “Images in Clinical Medicine” was commissioned by the editorial office without any funding or sponsorship. Dr. Qi serves as an Editor-in-Chief of AME Medical Journal. The authors have no other conflicts of interest to declare.

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References

1. Aguirre-Garcia J. Inflammatory pseudotumor of the liver. Ann Hepatol 2004;3:34. [PubMed]