An Enigmatic Liver Mass in a Child

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Diagnostic Imaging

Background:

• Hepatic space-occupying lesions in children present diagnostic difficulties due to diverse causes.
• Malignant and nonmalignant liver masses require distinct management strategies.
• Delayed diagnosis of pediatric liver masses can lead to suboptimal outcomes.

Observation:

• A 14-year-old boy presented with abdominal pain, fever, anorexia, weight loss, and jaundice.
• Imaging revealed an infiltrative liver mass, initially suspected as a fibrous tumor.
• Liver biopsy showed fibrosis and inflammation, with negative cultures and absent IgG4 staining.

Findings:

• Initial treatment with prednisolone for suspected inflammatory pseudotumor transformed the mass into a multicystic liver abscess.
• The patient required antibiotics and drainage, with subsequent improvement and abscess cavity formation.
• Histological confirmation is crucial to differentiate hepatic inflammatory pseudotumors from malignant neoplasms.

Implications:

• Hepatic inflammatory pseudotumors (IPTs) are rare and mimic malignant tumors on imaging.
• Prompt histological diagnosis is essential to prevent unnecessary surgical interventions.
• Cautious use of steroids in suspected IPTs is vital to avoid iatrogenic complications like chronic liver abscess.