Inflammatory pseudotumor of the liver--another case report. Is this the beginning of an established hepatic entity?

Background: Inflammatory pseudotumor of the liver is an infrequent, fibroinflammatory non-neoplastic process of unknown etiology, generally following a benign inflammatory condition. The importance of knowledge of it resides in its similar presentation to other hepatic tumors in clinical picture, radiological appearance, and macroscopic pattern.

Methods: A 71-year-old woman presented with acute abdominal pain. Ultrasonography and a computerized tomography (CT) scan showed a 3.2 cm hepatic tumor (segment IV) and a CT-guided liver biopsy revealed possible histological features of hepatic fibrosarcoma. The patient underwent a wedge resection. The pathologist identified a well-defined, 4-cm inflammatory pseudotumor of the liver associated with possible sclerosing cholangitis lesion.

Conclusions: Inflammatory pseudotumor is a fibroinflammatory non-neoplastic process that should be suspected in patients with a hepatic tumor with significant infectious-inflammatory history. Percutaneous hepatic biopsy does not provide certainty in confirming the lesion since it does not discard focuses of hidden malignancy. The treatment is surgical resection followed by histopatological study to eliminate a hepatocarcinoma, a low-grade fibrosarcoma, or a hidden focus of adenocarcinoma. The inflammatory pseudotumor of the liver has changed from being an extremely rare pathology to becoming an established liver disease.