Hepatic Inflammatory Pseudotumor

AUTHORS: DE SANTIS Adriano, LISI Daniele, LA GAETANA Emanuele Rosario  Rome, Italy.

This is a peculiar old case. A 74-year-old woman presented with right upper quadrant pain and low-grade fever. Laboratory tests revealed neutrophilic leukocytosis (WBC 16,000/mm³) and elevated inflammatory markers (erythrocyte sedimentation rate [ESR] 120 mm/h); liver transaminases, cholestasis indices, and tumor markers (CEA, CA 19-9, CA 125) were within normal limits. An upper abdominal ultrasound revealed a markedly heterogeneous lesion measuring approximately 10 cm in the right hepatic lobe (Figure 1), which was confirmed by a non-contrast abdominal CT scan (contrast was not administered due to a reported allergy; Figure 2). Abdominal MRI could not be performed due to the presence of a pacemaker. The patient underwent percutaneous liver biopsy, and histopathological examination showed an inflammatory infiltrate composed of lymphocytes and neutrophils, with no evidence of neoplastic cells or pathogenic microorganisms. The findings were consistent with a diagnosis of hepatic inflammatory pseudotumor. These lesions are benign and well-demarcated hepatic masses, typically discovered incidentally or during work-up for nonspecific symptoms (e.g., low-grade fever, abdominal pain). Etiology of IPT remains uncertain although infectious condition, autoimmune phenomenon, or systemic inflammatory response syndrome has been suggested as possible one. Optimal treatment and prognosis have not been established. Due to its diagnostic ambiguity, some cases with IPT of the liver were diagnosed and treated through surgical resection. Other cases were reported to be successfully managed with antibiotics, nonsteroidal anti-inflammatory drugs or no medication. The patient was managed conservatively with clinical observation. Follow-up ultrasounds at 1 month (Figure 3) and 4 months (Figure 4) demonstrated complete resolution of the lesion.