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Inflammatory pseudotumor of the liver associated with extrahepatic infection
J E White1, C W Chase, J E Kelley
1Department of Surgery, University of Tennessee College of Medicine, Chattanooga 37403, USA.
Abstract:
We present two cases that support an infectious cause of inflammatory pseudotumor of the liver. Each patient had sepsis due to chronic abdominal abscesses, along with a liver mass. Both patients had exploratory celiotomy, and histologic examination of the liver mass revealed inflammatory pseudotumor of the liver. Evidence of a mixed bacterial/Actinomyces infection was noted in hepatic tissue sections in one patient, and Bacteroides caccae was cultured directly from the liver biopsy in the other patient. This is the first known report of bacteria being cultured from biopsy specimens of a hepatic pseudotumor and the only reported case of Actinomyces within a hepatic pseudotumor. Clinical and pathologic findings in these two cases indicate that an extrahepatic infectious source should be explored as a potential cause of inflammatory pseudotumor of the liver.
Insights
This study suggests infections may cause inflammatory pseudotumor of the liver. Researchers found bacterial and Actinomyces infections in two patients with liver masses and sepsis, highlighting a potential infectious origin.
Area of Science:
- Hepatology
- Infectious Diseases
- Pathology
Background:
- Inflammatory pseudotumor of the liver (IPL) is a rare benign liver lesion.
- The etiology of IPL remains unclear, with various theories including neoplastic, inflammatory, and reactive processes.
- This study investigates a potential infectious etiology for IPL.
Observation:
- Two patients presented with sepsis secondary to chronic abdominal abscesses and concurrent liver masses.
- Histologic examination of liver masses revealed inflammatory pseudotumor.
- Microbial analysis identified mixed bacterial/Actinomyces infection in one case and Bacteroides caccae in the other.
Findings:
- This is the first report of bacteria cultured directly from a hepatic pseudotumor biopsy.
- This case also represents the first reported instance of Actinomyces within a hepatic pseudotumor.
- The findings support an infectious etiology for inflammatory pseudotumor of the liver.
Implications:
- These cases suggest that an extrahepatic infectious source should be considered in the differential diagnosis of hepatic pseudotumors.
- Identifying and treating underlying infections may be crucial for managing patients with IPL.
- Further research is warranted to elucidate the role of microbial agents in the pathogenesis of IPL.