Inflammatory Pseudotumor of the Liver

Ryuji Hirai, Nobuyoshi Shimizu, Hiroyuki Soga, Naoshi Usuki, Sumiji Sasaki*

The Second Department of Surgery, Okayama University, School of Medicine
*Department of Surgery, National Okayama Hospital

Inflammatory pseudotumor of the liver is a rare disease with only 55 cases reported throughout the world. It is difficult to distinguish this condition from malignant liver disease. We present a case of inflammatory pseudotumor of the liver and a review of the literature. A 46-year-old woman was referred to us for a liver tumor that had been discovered with ultrasound and CT scan in another hospital. She complained of epigastralgia and fever of 10 days duration, and was administrated antibiotics. On admission, her white blood cel count was 17,000/mm³. On physical examination, no palpable mass was found. A hyperechoic tumorous lesion was displayed in the left lateral segment, and gall stone was discovered. CT scan revealed a hypodense mass that was enhanced. Hepatic angiography exhibited a hypervascular lesion with a tumor stain. Endoscopic cholangiography showed stenosis of the left main hepatic duct and dilatation of the peripheral bile duct in the tumorous lesion. A common bile duct stone was also discovered. These findings were interpreted as a benign lesion, but malignant disease was not completely excluded. Left sided hepatic lobectomy, cholecystectomy and choledocho-lithotomy were performed. The cut surface of the resected material showed an ill-defined yellow mass lesion (7 cm at its greatest axis). Dilated intra-hepatic bile ducts were included in the lesion. The pathologic diagnosis was hepatic xanthogranuloma, which is compatible with so-called inflammatory pseudotumor of the liver.

Key words
inflammatory pseudotumor of the liver

Reprint requests
Ryuji Hirai The Second Department of Surgery, Okyama University, School of Medicine
2-5-1 Shikata-cho, Okayama, 700 JAPAN

Accepted
September 14, 1994

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