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Hepatic Inflammatory Pseudotumor Mimicking Malignant Tumor With Rare Onset of Intra-abdominal Hemorrhage
Kensuke Yamamura1, Toru Beppu2, Eri Oda1
1Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan.
Background:
Hepatic inflammatory pseudotumor (HIPT) is an uncommon benign tumor-like mass that mimics malignant tumors.
Case Report:
A 73-year-old man was admitted with severe epigastric pain and high fever. He had received choledocojejunostomy. Enhanced computed tomography showed a 76 mm, heterogeneous, gradual enhanced low-density mass in the caudate lobe and hyperdense fluid was detected around the mass. Based on the diagnosis of hemorrhage from a hypervascular malignant liver tumor, chemoembolization was conducted. Antibiotics (Meropenem) were administered for 2 weeks, and methylprednisolone (125 mg) was administered twice as a premedication for chemoembolization. After the 2nd chemoembolization, rapid tumor shrinkage was observed and the inflammatory changes gradually disappeared. The tumor was finally diagnosed as fibrohistiocytic type HIPT with an ultrasound-guided percutaneous tumor biopsy. The diameter of the liver tumor decreased to 15 mm and intra-abdominal hemorrhage disappeared in 3 months.
Conclusion:
Development of HIPT can be associated with intra-abdominal hemorrhage.
Insights
Hepatic inflammatory pseudotumor (HIPT) can present as a liver mass that mimics cancer. This case shows HIPT can be linked to intra-abdominal hemorrhage and successfully treated with chemoembolization.
Area of Science:
- Hepatology
- Oncology
- Radiology
Background:
- Hepatic inflammatory pseudotumor (HIPT) is a rare, benign liver mass.
- HIPT can be mistaken for malignant liver tumors on imaging.
Observation:
- A 73-year-old male presented with epigastric pain and fever.
- Imaging revealed a large caudate lobe mass with surrounding fluid, initially suspected as a hemorrhagic malignant tumor.
- The patient underwent chemoembolization and antibiotic treatment.
Findings:
- Chemoembolization led to significant tumor shrinkage and resolution of inflammatory changes.
- Percutaneous biopsy confirmed a fibrohistiocytic type HIPT.
- The liver tumor reduced from 76 mm to 15 mm within 3 months.
Implications:
- Intra-abdominal hemorrhage is a potential complication of HIPT.
- Chemoembolization may be an effective treatment for symptomatic HIPT.
- This case highlights the importance of considering HIPT in the differential diagnosis of liver masses.
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