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Phantom tumour : inflammatory pseudotumour of the liver : a rare case report and review of literature
Mann , Jesheen Shukla, Akash Patra, Biswa Ranjan
Mann , Jesheen
Shukla, Akash
Patra, Biswa Ranjan
Affiliation
George Eliot Hospital NHS Trust, Nuneaton; Sir H. N. Reliance Foundation Hospital, Mumbai, India; King Edward Memorial Hospital, Mumbai, India
Other Contributors
Publication date
2025-07-24
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Abstract
Introduction
The term ‘inflammatory pseudotumour’ (IPT) denotes a heterogeneous group of mass-forming lesions.1 IPT most commonly occurs in the lung, but it can be found in other locations, including the central nervous system, kidneys, ovaries, urinary bladder, breasts and liver.2
IPT of the liver (IPTL) is a rare benign lesion characterised by chronic infiltration of inflammatory cells and an area of fibrosis that closely mimics a malignant tumour.3,4
The aetiology and pathogenesis of IPTL remain unknown. There are no specific symptoms, laboratory or radiological findings that are useful for diagnosing IPTL. Differentiating between IPTs and other focal hepatic lesions remains a major problem. Treatment varies from observation and medical management to surgical resection in patients with severe symptoms or an indeterminate diagnosis.1,5,6
IPTs of the liver are extremely rare, and their exact prevalence remains unclear. This is largely because of the infrequency of the condition and its tendency to be misdiagnosed as malignant liver tumours.3
Materials and Methods
A 60-year-old Asian woman, with no relevant past medical history, presented with intermittent fever, vague abdominal pain and malaise. Laboratory tests revealed hyperbilirubinaemia, elevated liver enzymes, leucocytosis, and raised inflammatory markers. Imaging studies, including ultrasound and contrast-enhanced computed tomography (CT), showed a hypodense hepatic lesion with septations (Fig 1), initially suspected as a liver abscess. Despite empirical antibiotics and failed aspiration, the lesion persisted and progressed. Tumour markers, including CA 19-9, were elevated, raising suspicion for malignancy. Further evaluation with magnetic resonance imaging (MRI) demonstrated a targetoid enhancing lesion, prompting a CT-guided biopsy. Histopathology confirmed a diagnosis of inflammatory pseudotumor with xanthogranulomatous inflammation (Fig 2). The patient was managed conservatively with corticosteroids and monitored.
Results and Discussion
The patient responded well to corticosteroid therapy, with resolution of symptoms and normalisation of liver function tests. Follow-up imaging at 6 months showed gradual regression of the lesion. IPTs are often mistaken for malignancies because of their imaging findings and non-specific presentation.4 Although elevated CA 19-9 levels have been reported in IPTs, they have low specificity and other differentials include liver abscesses and malignancies.7 Radiologically, IPTs typically appear as hypoechoic lesions with heterogeneous enhancement on CT and MRI.2 The definitive diagnosis relies on histopathology, which would reveal mixed inflammatory infiltrates, fibrosis and foamy macrophages characteristic of xanthogranulomatous inflammation.8
Conclusion
This case highlights the diagnostic challenge of hepatic IPTs, which can closely mimic malignancies. Since there is potential for spontaneous regression or response to corticosteroids, early histopathological confirmation is helpful to prevent unindicated hepatic resection. Radiologically guided core biopsy with immunohistochemistry should be considered in cases of atypical liver lesions with inflammatory features.
Citation
Mann J, Shukla A, Patra BR. Phantom tumour: inflammatory pseudotumour of the liver: a rare case report and review of literature. Clin Med (Lond). 2025;25(4 Suppl):100442. doi: 10.1016/j.clinme.2025.100442.1.
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Conference Output