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Vascular invasion by hepatic inflammatory pseudotumor. A clinicopathologic study
T A Broughan1, W L Fischer, R J Tuthill
1Department of Surgery, Cleveland Clinic Foundation, Ohio.
Cancer
|May 15, 1993
Summary
Inflammatory pseudotumors (IPT) can occur in the liver and invade major blood vessels. Early and aggressive evaluation of hepatic masses is crucial due to the challenging diagnosis of IPT.
Area of Science:
- Hepatology
- Surgical Pathology
- Oncology
Background:
- Inflammatory pseudotumors (IPT) are increasingly recognized lesions composed of fibrous tissue, lymphocytes, histiocytes, and plasma cells.
- Hepatic IPT invading the inferior vena cava represents a rare clinical presentation.
Observation:
- A large hepatic tumor was surgically resected using cardiopulmonary bypass and circulatory arrest.
- Gross examination revealed a malignancy-like appearance with invasion into the vena cava.
- Microscopic analysis showed a mixed inflammatory infiltrate without evidence of neoplasia.
Findings:
- Histologic, immunohistologic, flow cytometry, and gene rearrangement analyses were performed.
- DNA flow cytometry excluded aneuploidy, and genetic analysis showed no clonal expansion of lymphocytes or plasma cells.
- The lesion was confirmed as an inflammatory pseudotumor.
Implications:
- Hepatic IPT can exhibit vascular invasion and biliary obstruction, complicating diagnosis and treatment.
- The diagnostic difficulty of IPT necessitates an aggressive approach to evaluating hepatic masses.
- Prompt surgical intervention may be required for symptomatic or invasive hepatic lesions.