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Ultraschall Med 2006; 27(3): 273-279
DOI: 10.1055/s-2005-858530
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© Georg Thieme Verlag KG Stuttgart · New York

Der inflammatorische Pseudotumor - eine schwierige Differenzialdiagnose

The Infammatory Pseudotumour - an Unusual Liver TumourG. Schuessler1 , C. Fellbaum2 , F. Fauth3 , V. Jacobi4 , A. Schmidt-Matthiesen5 , A. Ignee1 , C. F. Dietrich1
  • 1Medizinische Klinik II, jetzt: Innere Medizin 2, Caritaskrankenhaus Bad Mergentheim, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • 2Senkenbergisches Institut für Pathologie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • 3Medizinische Klinik III, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • 4Institut für Interventionelle Radiologie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • 5Chirurgische Klinik, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
Further Information

Publication History

eingereicht: 16.10.2003

angenommen: 22.5.2005

Publication Date:
25 October 2005 (online)

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Zusammenfassung

Wir berichten über einen Patienten, in dessen Leber durch Computertomographie und Ultraschall maligne imponierende Raumforderungen und vergrößerte perihepatische Lymphknoten beschrieben wurden. Unter dem Verdacht eines Tumorleidens und zur Gewinnung einer histologischen Probe bei unklarem Primärtumor wurde der Patient laparotomiert. Histologisch konnte ein inflammatorischer Pseudotumor der Leber nachgewiesen werden. Diese seltene Erkrankung kann Symptome wie Fieber, Oberbauchbeschwerden, Erbrechen, Gewichtsverlust und allgemeines Krankheitsgefühl verursachen, die häufig an einen malignen Tumor oder einen Abszess denken lassen. Die definitive Diagnostik sollte histologisch erfolgen.

Abstract

We report on a 49-year-old male patient who was suspected to have a malignant liver tumour with enlarged perihepatic lymph nodes because of CT and ultrasound scanning. To verify the diagnosis and procure a histological specimen, the patient underwent laparotomy. Histologically, an inflammatory pseudotumour could be confirmed. This is a rare disease which can present with fever, abdominal pain, vomiting and weight loss indicating malignancy or abscess. The definite diagnosis is often only verified by surgery.

Schlüsselwörter

inflammatorischer Pseudotumor - Feinnadelpunktion - Ultraschall - MRT - CT

Key words

Inflammatory pseudotumour - fine needle biopsy - ultrasound - MRI - CT

Literatur

  • 1 Orosz Z, Besznyak I. Diffuse Inflammatory Pseudotumor of the Testis, the Epididymis and the Spermatic Cord.  Pathol Oncol Res. 1995;  1 75-79
    PubMedSearch in Google Scholar
  • 2 Sanders B M, West K W, Gingalewski C. et al . Inflammatory pseudotumor of the alimentary tract: clinical and surgical experience.  J Pediatr Surg. 2001;  36 169-173
    PubMedSearch in Google Scholar
  • 3 Zennaro H, Laurent F, Vergier B. et al . Inflammatory myofibroblastic tumor of the lung (inflammatory pseudotumor): uncommon cause of solitary pulmonary nodule.  Eur Radiol. 1999;  9 1205-1207
    CrossrefPubMedSearch in Google Scholar
  • 4 Pack G T, Baker H W. Total right hepatic lobectomy; report of a case.  Ann Surg. 1953;  138 253-258
    CrossrefPubMedSearch in Google Scholar
  • 5 Gollapudi P, Chejfec G, Zarling E J. Spontaneous regression of hepatic pseudotumor.  Am J Gastroenterol. 1992;  87 214-217
    PubMedSearch in Google Scholar
  • 6 Anthony P P, Telesinghe P U. Inflammatory pseudotumour of the liver.  J Clin Pathol. 1986;  39 761-768
    CrossrefPubMedSearch in Google Scholar
  • 7 Horiuchi R, Uchida T, Kojima T. et al . Inflammatory pseudotumor of the liver. Clinicopathologic study and review of the literature.  Cancer. 1990;  65 1583-1590
    CrossrefPubMedSearch in Google Scholar
  • 8 Schmid A, Janig D, Bohuszlavizki A. et al . Inflammatory pseudotumor of the liver presenting as incidentaloma: report of a case and review of the literature.  Hepatogastroenterology. 1996;  43 1009-1014
    PubMedSearch in Google Scholar
  • 9 White J E, Chase C W, Kelley J E. et al . Inflammatory pseudotumor of the liver associated with extrahepatic infection.  South Med J. 1997;  90 23-29
    PubMedSearch in Google Scholar
  • 10 Yoon K H, Ha H K, Lee J S. et al . Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation.  Radiology. 1999;  211 373-379
    PubMedSearch in Google Scholar
  • 11 Abehsera M, Vilgrain V, Belghiti J. et al . Inflammatory pseudotumor of the liver: radiologic-pathologic correlation.  J Comput Assist Tomogr. 1995;  19 80-83
    PubMedSearch in Google Scholar
  • 12 Brunello F, Caremani M, Marcarino C. et al . Inflammatory pseudotumour of the liver: diagnosis by fine needle biopsy in two cases and a review of the literature.  Ital J Gastroenterol. 1994;  26 151-153
    PubMedSearch in Google Scholar
  • 13 de la Fernandez P uebla Gimenez RA, Garcia A J, Lechuga V arona MT. et al . [Hepatic inflammatory pseudotumor: apropos a case with a response to steroid treatment].  Gastroenterol Hepatol. 1999;  22 14-17
    PubMedSearch in Google Scholar
  • 14 Fukuya T, Honda H, Matsumata T. et al . Diagnosis of inflammatory pseudotumor of the liver: value of CT.  AJR Am J Roentgenol. 1994;  163 1087-1091
    PubMedSearch in Google Scholar
  • 15 Gabrielli G B, Casaril M, Stanzial A M. et al . [Costal osteolytic lesions and multiple hepatic neoformations in a patient with inflammatory pseudotumor].  Ann Ital Med Int. 2000;  15 226-231
    PubMedSearch in Google Scholar
  • 16 Gluszek S, Kot M, Czerwaty M. Inflammatory pseudotumor of the liver treated surgically.  Hepatogastroenterology. 1999;  46 2959-2960
    PubMedSearch in Google Scholar
  • 17 Hsiao C C, Chen C L, Eng H L. Inflammatory pseudotumor of the liver in Kostmann’s disease.  Pediatr Surg Int. 1999;  15 266-269
    CrossrefPubMedSearch in Google Scholar
  • 18 Ishida H, Tatsuta M, Furukawa H. et al . Multiple inflammatory pseudotumors mimicking liver metastasis from colon cancer: report of a case.  Surg Today. 2000;  30 530-533
    CrossrefPubMedSearch in Google Scholar
  • 19 Jais P, Berger J F, Vissuzaine C. et al . Regression of inflammatory pseudotumor of the liver under conservative therapy.  Dig Dis Sci. 1995;  40 752-756
    CrossrefPubMedSearch in Google Scholar
  • 20 Koea J B, Broadhurst G W, Rodgers M S. et al . Inflammatory pseudotumor of the liver: demographics, diagnosis, and the case for nonoperative management.  J Am Coll Surg. 2003;  196 226-235
    CrossrefPubMedSearch in Google Scholar
  • 21 Krech R H, Erhardt-Domagalski M, Neumann H. Inflammatory pseudotumor of the liver. Morphologic and cytophotometry studies and differential diagnosis.  Pathologe. 1995;  16 415-420
    CrossrefPubMedSearch in Google Scholar
  • 22 Loke K L, Chan C S, Wijesinha S S. Case report: inflammatory pseudotumour of liver-review of clinical and radiological features.  Clin Radiol. 1994;  49 575-577
    PubMedSearch in Google Scholar
  • 23 Lyons T J, Benbow E W, Taylor P M. et al . Inflammatory pseudotumour of the liver: antecedent causes and clinical experience.  J Hepatol. 1993;  19 273-278
    CrossrefPubMedSearch in Google Scholar
  • 24 Mathiak G, Meyer-Pannwitt U, Mathiak M. et al . Inflammatory pseudotumor of the liver-rare differential diagnosis of undetermined hepatic space-occupying lesion. Case report and review of the literature.  Langenbecks Arch Chir. 1996;  381 309-317
    PubMedSearch in Google Scholar
  • 25 Maze G L, Lee M, Schenker S. Inflammatory pseudotumor of the liver and pregnancy.  Am J Gastroenterol. 1999;  94 529-530
    CrossrefPubMedSearch in Google Scholar
  • 26 Ogawa T, Yokoi H, Kawarada Y. A case of inflammatory pseudotumor of the liver causing elevated serum CA19 - 9 levels.  Am J Gastroenterol. 1998;  93 2551-2555
    CrossrefPubMedSearch in Google Scholar
  • 27 Passalides A, Keramidas D, Mavrides G. Inflammatory pseudotumor of the liver in children. A case report and review of the literature.  Eur J Pediatr Surg. 1996;  6 35-37
    PubMedSearch in Google Scholar
  • 28 Shek T W, Ng I O, Chan K W. Inflammatory pseudotumor of the liver. Report of four cases and review of the literature.  Am J Surg Pathol. 1993;  17 231-238
    PubMedSearch in Google Scholar
  • 29 Strohm W D, Stahle K S, Schumm G. Inflammatory pseudotumor of the liver. Case report of a rare differential diagnosis of hepatocellular carcinoma.  Z Gastroenterol. 1996;  34 132-137
    PubMedSearch in Google Scholar
  • 30 Toda K, Yasuda I, Nishigaki Y. et al . Inflammatory pseudotumor of the liver with primary sclerosing cholangitis.  J Gastroenterol. 2000;  35 304-309
    CrossrefPubMedSearch in Google Scholar
  • 31 Vanthournout I, Coche G, Sevenet F. et al . Inflammatory pseudotumors of the liver. Apropos of a pediatric case with radiological and ultrasonographic features and anatomopathological correlations.  J Radiol. 1998;  79 553-556
    PubMedSearch in Google Scholar
  • 32 Torzilli G, Inoue K, Midorikawa Y. et al . Inflammatory pseudotumors of the liver: prevalence and clinical impact in surgical patients.  Hepatogastroenterology. 2001;  48 1118-1123
    PubMedSearch in Google Scholar
  • 33 Yamaguchi M, Yamamoto T, Tate G. et al . Specific detection of epstein-barr virus in inflammatory pseudotumor of the spleen in a patient with a high serum level of soluble IL-2 receptor.  J Gastroenterol. 2000;  35 563-566
    CrossrefPubMedSearch in Google Scholar
  • 34 Anthony P P. Inflammatory pseudotumour (plasma cell granuloma) of lung, liver and other organs.  Histopathology. 1993;  23 501-503
    CrossrefPubMedSearch in Google Scholar
  • 35 Le Borgne  J, Lehur P A, Bitar O. et al . Inflammatory pseudo-tumors of the liver. Apropos of 2 cases.  Chirurgie. 1991;  117 840-846
    PubMedSearch in Google Scholar
  • 36 Lupovitch A, Chen R, Mishra S. Inflammatory pseudotumor of the liver. Report of the fine needle aspiration cytologic findings in a case initially misdiagnosed as malignant.  Acta Cytol. 1989;  33 259-262
    PubMedSearch in Google Scholar
  • 37 Kafeel G, Telesinghe P U. Inflammatory pseudotumour of the liver.  J Clin Pathol. 1997;  50 352-353
    PubMedSearch in Google Scholar
  • 38 Standiford S B, Sobel H, Dasmahapatra K S. Inflammatory pseudotumor of the liver.  J Surg Oncol. 1989;  40 283-287
    CrossrefPubMedSearch in Google Scholar
  • 39 Lee S L, DuBois J J. Hepatic inflammatory pseudotumor: case report, review of the literature, and a proposal for morphologic classification.  Pediatr Surg Int. 2001;  17 555-559
    CrossrefPubMedSearch in Google Scholar
  • 40 Someren A. „Inflammatory pseudotumor” of liver with occlusive phlebitis: report of a case in a child and review of the literature.  Am J Clin Pathol. 1978;  69 176-181
    PubMedSearch in Google Scholar
  • 41 Voss S D, Kruskal J B, Kane R A. Chronic inflammatory pseudotumor arising in the hepatobiliary-pancreatic system: progressive multisystemic organ involvement in four patients.  AJR Am J Roentgenol. 1999;  173 1049-1054
    PubMedSearch in Google Scholar
  • 42 Zavaglia C, Barberis M, Gelosa F. et al . Inflammatory pseudotumour of the liver with malignant transformation. Report of two cases.  Ital J Gastroenterol. 1996;  28 152-159
    PubMedSearch in Google Scholar
  • 43 Broughan T A, Fischer W L, Tuthill R J. Vascular invasion by hepatic inflammatory pseudotumor. A clinicopathologic study.  Cancer. 1993;  71 2934-2940
    PubMedSearch in Google Scholar
  • 44 Pecorella I, Ciardi A, Memeo L. et al . Inflammatory pseudotumour of the liver-evidence for malignant transformation.  Pathol Res Pract. 1999;  195 115-120
    PubMedSearch in Google Scholar
  • 45 Coffin C M, Humphrey P A, Dehner L P. Extrapulmonary inflammatory myofibroblastic tumor: a clinical and pathological survey.  Semin Diagn Pathol. 1998;  15 85-101
    CrossrefPubMedSearch in Google Scholar
  • 46 Treissman S P, Gillis D A, Lee C L. et al . Omental-mesenteric inflammatory pseudotumor. Cytogenetic demonstration of genetic changes and monoclonality in one tumor.  Cancer. 1994;  73 1433-1437
    PubMedSearch in Google Scholar
  • 47 Biselli R, Ferlini C, Fattorossi A. et al . Inflammatory myofibroblastic tumor (inflammatory pseudotumor): DNA flow cytometric analysis of nine pediatric cases.  Cancer. 1996;  77 778-784
    CrossrefPubMedSearch in Google Scholar
  • 48 Nakajima T, Sugano I, Matsuzaki O. et al . Hepatic inflammatory lesions manifested as a pseudotumor. Report of two cases with different characteristics.  Arch Pathol Lab Med. 1993;  117 157-159
    PubMedSearch in Google Scholar
  • 49 Hirasawa R, Shimohara Y, Yabe H. et al . [A case of inflammatory pseudotumor of the liver].  Nippon Naika Gakkai Zasshi. 1988;  77 1710-1714
    PubMedSearch in Google Scholar
  • 50 Flisak M E, Budris D M, Olson M C. et al . Inflammatory pseudotumor of the liver: appearance on MRI.  Clin Imaging. 1994;  18 1-3
    CrossrefPubMedSearch in Google Scholar
  • 51 Kessler E, Turani H, Kayser S. et al . Inflammatory pseudotumor of the liver.  Liver. 1988;  8 17-23
    PubMedSearch in Google Scholar
  • 52 Imazato M, Isobe Y, Ueno E. Inflammatory pseudotumor of the liver.  AJR Am J Roentgenol. 1990;  154 201
    PubMedSearch in Google Scholar
  • 53 Nasir A, Budhrani S S, Hafner G H. et al . Inflammatory pseudotumor of the spleen associated with a cavernous hemangioma diagnosed at intraoperative cytology: report of a case and review of literature.  In Vivo. 1999;  13 87-92
    PubMedSearch in Google Scholar
  • 54 Coffin C M, Watterson J, Priest J R. et al . Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases.  Am J Surg Pathol. 1995;  19 859-872
    Search in Google Scholar
  • 55 Craig J, Peters R, Edmondson H. Atlas of tumor pathology. Washington DC; Armed Forces Institute of Pathology 1989
    Search in Google Scholar
  • 56 Stuckmann G, Flury R, Heinz W. et al . [Inflammatory myofibroblastic tumour (so-called pseudotumour) of the hepatobiliary system].  Ultraschall Med. 2004;  25 (5) 373-376
    Thieme ConnectPubMedSearch in Google Scholar
  • 57 Broughan T A, Fischer W L, Tuthill R J. Vascular invasion by hepatic inflammatory pseudotumor. A clinicopathologic study.  Cancer. 1993;  71 2934-2940
    PubMedSearch in Google Scholar
  • 58 Tanino M, Ohta G. [An autopsy case of xanthogranuloma in the liver (author’s transl)].  Nippon Shokakibyo Gakkai Zasshi. 1981;  78 1803-1806
    PubMedSearch in Google Scholar
  • 59 Albrecht T, EFSUMB S tudy Group. Guidelines for the Use of Contrast Agents in Ultrasound.  Ultraschall in Med. 2004;  25 249-256
    Thieme ConnectPubMedSearch in Google Scholar
  • 60 Albrecht T, Hoffmann C W, Schmitz S A. et al . Phase-inversion sonography during the liver-specific late phase of contrast enhancement: improved detection of liver metastases.  AJR Am J Roentgenol. 2001;  176 1191-1198
    PubMedSearch in Google Scholar
  • 61 Harvey C J, Blomley M J, Eckersley R J. et al . Pulse-inversion mode imaging of liver specific microbubbles: improved detection of subcentimetre metastases.  Lancet. 2000;  355 807-808
    CrossrefPubMedSearch in Google Scholar
  • 62 Bernatik T, Becker D, Neureiter D. et al . Lebermetastasendetektion - Vergleich Kontrastmittel - Ultraschall mit Echosignalverstärkern der ersten versus zweiten Generation.  Ultraschall in Med. 2003;  24 175-179
    Thieme ConnectPubMedSearch in Google Scholar
  • 63 Dietrich C F, Ignee A, Trojan J. et al . Improved characterization of histologically proven liver tumours by contrast enhanced ultrasonography during the portal venous and specific late phase of SHU 508A.  Gut. 2004;  53 401-405
    CrossrefPubMedSearch in Google Scholar
  • 64 von Herbay A, Vogt C, Haussinger D. Late-phase pulse-inversion sonography using the contrast agent levovist: differentiation between benign and malignant focal lesions of the liver.  AJR Am J Roentgenol. 2002;  179 1273-1279
    CrossrefPubMedSearch in Google Scholar
  • 65 Dietrich C F, Schuessler G, Trojan J. et al . Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast enhanced ultrasonography.  Br J Radiol. 2005, in press; 
    PubMedSearch in Google Scholar
  • 66 Weiler H, Kersjes   W, Herrmann G. Vortäuschung von Lebermetastasen durch Galleninfarkte.  Ultraschall in Med. 2004;  292-295
    PubMedSearch in Google Scholar

Prof. Dr. med. Christoph F. Dietrich

Innere Medizin 2, Caritaskrankenhaus Bad Mergentheim

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97980 Bad Mergentheim

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Email: Christoph.dietrich@ckbm.de