Volume 49, Issue 8 pp. 726-730

Inflammatory pseudotumor of the liver in a patient with chronic hepatitis C: Difficulty in differentiating it from hepatocellular carcinoma

Soo Ryang Kim

Soo Ryang Kim

Departments of Gastroenterology and

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Yoshitake Hayashi

Yoshitake Hayashi

First Department of Pathology, Kobe University School of Medicine, Kobe,

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Masatoshi Kudo

Masatoshi Kudo

Second Department of Internal Medicine, Kinki University School of Medicine, Sayama,

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Toshiyuki Matsuoka

Toshiyuki Matsuoka

Department of Radiology, Osaka City University Medical School, Osaka and

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Susumu Imoto

Susumu Imoto

Departments of Gastroenterology and

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Kazunori Sasaki

Kazunori Sasaki

Departments of Gastroenterology and

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Shigeyuki Shintani

Shigeyuki Shintani

Departments of Gastroenterology and

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Kyung Boo Song

Kyung Boo Song

Departments of Gastroenterology and

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Sok Yong Park

Sok Yong Park

Departments of Gastroenterology and

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Jung Hyo Kim

Jung Hyo Kim

Departments of Gastroenterology and

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Kenji Ando

Kenji Ando

Departments of Gastroenterology and

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Toshihiro Koterazawa

Toshihiro Koterazawa

Departments of Gastroenterology and

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Ke Ih Kim

Ke Ih Kim

Pharmacy, Kobe Asahi Hospital,

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Toshiaki Ninomiya

Toshiaki Ninomiya

Second Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan

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First published: 04 January 2002
Citations: 18
Correspondence: SooRyang Kim, Department of Gastroenterology, Kobe Asahi Hospital, 3–5-25 Bouoji-cho, Nagata-ku, Kobe 653-0801, Japan. Email: < [email protected]>

Abstract

A case of an inflammatory pseudotumor of the liver in a 75-year-old female with chronic hepatitis C whose radiologic features simulated that of hepatocellular carcinoma (HCC) is presented. On imaging studies, hypervascularity by CO2 ultrasound (US) angiography, enhancement at an early phase and isodensity at a late phase by incremental dynamic computed tomography (CT), perfusion defect by CT during arteriography (CTAP), and clinical background of hepatitis C virus (HCV) infection strongly suggested HCC. A US-guided needle biopsy revealed a mainly diffuse and polyclonal proliferation of lymphocytes positive for leukocyte common antigen (pan-lymphocyte cells), L-26 (B cell lymphocytes), and UCHL-1 (T cell lymphocytes), negative for both κ and λ light chains and sparsely distributed neutrophils and histiocytes. No lymphoid follicles were observed. The liver tissue around this tumor showed chronic hepatitis with mild activity and mild fibrosis. These histopathologic findings suggested that the diagnosis of inflammatory pseudotumor of the liver was tenable. As it is difficult to differentiate between inflammatory pseudotumor of the liver and HCC by imaging studies alone, supplemental biopsy, where possible, should be obtained when diagnostic imaging of tumors suggesting HCC is carried out. We emphasize that histopathology is a true gold standard in the diagnosis of this disease.

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