APMIS zyxwvutsrqp 98: zyxwvutsr 1022-1026, 1990 Inflammatory pseudotumor of the liver Report of a case and literature review JOSE I. LOPEZ', BEATRIZ EIZAGUIRRE', MANUEL NEVADO' and JUAN C. RUIZ-JAUREGUIZURIA* 'The Services of Pathology and 'Radiology, Hospital Civil de Bilbao, Bilbao, Vizcaya, Spain Lopez, J. I., Eizaguirre, B., Nevado, M. zyxwvut & Ruiz-Jaureguizuria,J. C. Inflammatory pseudotumor of the liver. Report of a case and literature review. APMIS 98: 1022-1026, 1990. The radiologic and histologic features of an inflammatory pseudotumor of the liver in a 62-year-old man are presented. The lesion was coincidentally discovered during clinical work-up of an acute pancreatitis caused by choledocholithiasis. Malignancy was suspected in the light of the radiologic presentation. To our knowledge, only 23 cases of inflammatory pseudotumor of the liver have appeared in the international literature. Its etiology remains unknown, although reactive-inflammatory or infectious mechanisms have been suggested. The present case seemed to be associated with bile flow obstruction, as the mass partially regressed following cholecystectomy and Vaterian sphincterotomy. Therefore, a hypothetical obstructive pathogenetic mechanism is considered. We conclude that this tumor-like condition must be considered in the differential diagnosis of solid masses in the liver. Key words: Liver; inflammatory pseudotumor; plasma cells; bile flow obstruction. J o d I. Lopez, Servicio de Anatomia Patologica, Hospital Civil de Bilbao, Avda. de Montevideo 18,480 13 Bilbao, Vizcaya, Spain. The so-called inflammatory pseudotumor was originally described in the lung zyxwvuts (Bahadori & Liebow 1973, Mason et al. 1963). Later, other sites have been reported and various names proposed (Cotelingam & Jafe 1984, Eimoto et al. 1978, Garner 1973, Gonzalez-Crussi 1975, Holck 198 1, Zsaacson et al. 1978, Wu et al. 1973). To our knowledge, only 23 cases inflammatory pseudotu- mor of the liver have been published (Anthony & Telesinghe 1986, Chen 1984, Collina et al. 1987, Grouls 1987, Haith et al. 1964, Heneghan et al. 1984, Hertzer et al. 1971, Jimenez-Mejias et al. 1989, Kessler et al. 1988, Li et al. 1989, Lupovitch et al. 1989, Pack & Baker 1953, Paineau et al. 1983, Someren 1978). Here we report a case of inflammatory pseudo- tumor of the liver found coincidentally in a patient with an acute pancreatitis. Its radiologic and mor- Received February 16, 1990. Accepted April 23, 1990. phologic features are presented with emphasis on the differential diagnosis of solid hepatic masses. Pathogenetic mechanisms are reviewed and dis- cussed. CASE REPORT zyx A 62-year-old man, with a previous history of type I1 diabetes mellitus and cholelithiasis, was referred because of abdominal pain, dyspepsia, and fever. Blood analysis: glucose 245 mg/dl., amylase 4340 U/l., lipase 2568 U/l., alkaline phosphatase 995 U/l. Urine analysis: amylase 41400 U/l. Serologic tests were within normal limits. Abdominal echography showed cholelithiasis, choledo- cholithiasis and a lobated, solid, and hypoechoic intra- hepatic mass (Fig. I). CT scan revealed a solid, hypo- dense, and poorly delimited lesion measuring approxi- mately 10 x 7 cm in the right hepatic lobe (Fig. 2A). Subesquent contrast perfusion demonstrated an irregu- lar captation of the mass, showing a mixture of hypo- dense and isodense areas (Fig. 2B). No conclusive diagnosis was made, but malignancy (primary or metastatic) was suspected. Biopsy of the hepatic mass was performed during cholecystectomy. 1022