Limits...
Inflammatory pseudotumor of the liver diagnosed as metastatic liver tumor in a patient with a gastrointestinal stromal tumor of the rectum: report of a case.

Matsuo Y, Sato M, Shibata T, Morimoto M, Tsuboi K, Shamoto T, Hirokawa T, Sato T, Takahashi H, Takeyama H - World J Surg Oncol (2014)

Bottom Line: Differential diagnosis between IPT and malignant neoplasms is difficult.Moreover, FDG-PET revealed strong uptake in the tumor.This patient is discussed along with a review of the literature.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan. matsuo@med.nagoya-cu.ac.jp.

ABSTRACT

Background: Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion. A case of IPT of the liver found in association with a malignant gastrointestinal stromal tumor (GIST) is reported.

Case report: A 74-year-old man was admitted to our hospital for a liver tumor. He previously underwent rectal amputation for a malignant GIST. Computed tomography (CT) revealed a low-density area in the liver and dynamic contrast-enhanced MRI (EOB-MRI) showed that the tumor was completely washed out in the delayed phase. 18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) showed strong uptake in the liver. A diagnosis of liver metastasis was made and partial hepatectomy was performed. Microscopic examination showed that the tumor was an IPT.

Conclusion: Differential diagnosis between IPT and malignant neoplasms is difficult. Moreover, FDG-PET revealed strong uptake in the tumor. To our knowledge, this is the first patient reported to have an IPT in association with a rectal GIST. This patient is discussed along with a review of the literature.

Show MeSH

Related in: MedlinePlus

18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) findings. FDG-PET showed strong uptake in the liver (arrow). No other abnormal uptake was observed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4016664&req=5

Figure 3: 18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) findings. FDG-PET showed strong uptake in the liver (arrow). No other abnormal uptake was observed.

Mentions: Nine years after surgery, follow-up CT revealed a 14-mm low-density area in segment 8 of the liver. The periphery of this area was nonhomogeneously enhanced by contrast medium and appeared isodense in the late phase compared to surrounding normal liver tissue (Figure 1). Retrospectively, the tumor was just about identifiable on a CT scan acquired six months previously, and had grown bigger in the interim. Laboratory data were all within normal ranges, except for a slightly elevated C-reactive protein (CRP) level of 0.6 mg/dL. Hepatitis B surface antigen, hepatitis B e-antigen, and hepatitis C virus antibody were negative. Serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), and α-fetoprotein (AFP) were all within normal ranges. On dynamic contrast-enhanced magnetic resonance imaging (MRI) with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (EOB-MRI), the tumor appeared to be isointense in the arterial phase and was completely washed out in the delayed and hepatocyte phases (Figure 2). There was no finding on both gastroscopy and colonoscopy. Based on these results, the tumor was suspected to be a metastatic tumor of the rectal GIST. FDG-PET was performed to confirm that the tumor was malignant, and showed strong uptake in the liver (Figure 3). No other abnormal uptake was observed. Surgical oncologists, medical oncologists, and radiologists discussed this case for multidisciplinary management. Considering the patient’s history combined with the radiological findings, a diagnosis of metastatic malignant GIST from the previous rectal lesion was made, and partial hepatectomy was performed. The tumor was well-circumscribed, solid, and yellowish-white in color (Figure 4). No evidence of necrosis or hemorrhage was present. Microscopic examination of the paraffin section of the liver ‘tumor’ showed that it was composed of fascicles of spindle cells, such as fibroblasts and myofibroblasts, accompanied by many lymphocytes, plasma cell, neutrophils, and macrophages (Figure 5). No mitotic cells were observed in these spindle cells. IHC studies of the spindle cells showed positive staining for smooth muscle actin (SMA) and vimentin, and negative staining for desmin, CD34, and cytokeratin AE1/3. Thus, the spindle cells were diagnosed as myofibroblasts. IHC studies of white blood cells revealed that the majority of lymphocytes expressed CD3 and some cells expressed CD20. Moreover, IHC revealed some IgG4-positive plasma cells. Since no evidence of malignancy was apparent, this case was diagnosed as IPT of the liver. The patient recovered well after surgery and was discharged without complications. He was followed-up regularly in our outpatient clinic, with half-yearly CT scans and blood tests. The patient remains asymptomatic and free of disease four years after his last surgery.


Inflammatory pseudotumor of the liver diagnosed as metastatic liver tumor in a patient with a gastrointestinal stromal tumor of the rectum: report of a case.

Matsuo Y, Sato M, Shibata T, Morimoto M, Tsuboi K, Shamoto T, Hirokawa T, Sato T, Takahashi H, Takeyama H - World J Surg Oncol (2014)

18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) findings. FDG-PET showed strong uptake in the liver (arrow). No other abnormal uptake was observed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4016664&req=5

Figure 3: 18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) findings. FDG-PET showed strong uptake in the liver (arrow). No other abnormal uptake was observed.
Mentions: Nine years after surgery, follow-up CT revealed a 14-mm low-density area in segment 8 of the liver. The periphery of this area was nonhomogeneously enhanced by contrast medium and appeared isodense in the late phase compared to surrounding normal liver tissue (Figure 1). Retrospectively, the tumor was just about identifiable on a CT scan acquired six months previously, and had grown bigger in the interim. Laboratory data were all within normal ranges, except for a slightly elevated C-reactive protein (CRP) level of 0.6 mg/dL. Hepatitis B surface antigen, hepatitis B e-antigen, and hepatitis C virus antibody were negative. Serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), and α-fetoprotein (AFP) were all within normal ranges. On dynamic contrast-enhanced magnetic resonance imaging (MRI) with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (EOB-MRI), the tumor appeared to be isointense in the arterial phase and was completely washed out in the delayed and hepatocyte phases (Figure 2). There was no finding on both gastroscopy and colonoscopy. Based on these results, the tumor was suspected to be a metastatic tumor of the rectal GIST. FDG-PET was performed to confirm that the tumor was malignant, and showed strong uptake in the liver (Figure 3). No other abnormal uptake was observed. Surgical oncologists, medical oncologists, and radiologists discussed this case for multidisciplinary management. Considering the patient’s history combined with the radiological findings, a diagnosis of metastatic malignant GIST from the previous rectal lesion was made, and partial hepatectomy was performed. The tumor was well-circumscribed, solid, and yellowish-white in color (Figure 4). No evidence of necrosis or hemorrhage was present. Microscopic examination of the paraffin section of the liver ‘tumor’ showed that it was composed of fascicles of spindle cells, such as fibroblasts and myofibroblasts, accompanied by many lymphocytes, plasma cell, neutrophils, and macrophages (Figure 5). No mitotic cells were observed in these spindle cells. IHC studies of the spindle cells showed positive staining for smooth muscle actin (SMA) and vimentin, and negative staining for desmin, CD34, and cytokeratin AE1/3. Thus, the spindle cells were diagnosed as myofibroblasts. IHC studies of white blood cells revealed that the majority of lymphocytes expressed CD3 and some cells expressed CD20. Moreover, IHC revealed some IgG4-positive plasma cells. Since no evidence of malignancy was apparent, this case was diagnosed as IPT of the liver. The patient recovered well after surgery and was discharged without complications. He was followed-up regularly in our outpatient clinic, with half-yearly CT scans and blood tests. The patient remains asymptomatic and free of disease four years after his last surgery.

Bottom Line: Differential diagnosis between IPT and malignant neoplasms is difficult.Moreover, FDG-PET revealed strong uptake in the tumor.This patient is discussed along with a review of the literature.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, 4678601, Japan. matsuo@med.nagoya-cu.ac.jp.

ABSTRACT

Background: Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion. A case of IPT of the liver found in association with a malignant gastrointestinal stromal tumor (GIST) is reported.

Case report: A 74-year-old man was admitted to our hospital for a liver tumor. He previously underwent rectal amputation for a malignant GIST. Computed tomography (CT) revealed a low-density area in the liver and dynamic contrast-enhanced MRI (EOB-MRI) showed that the tumor was completely washed out in the delayed phase. 18Fluorine-fluorodeoxyglucose positron emission tomography (FDG-PET) showed strong uptake in the liver. A diagnosis of liver metastasis was made and partial hepatectomy was performed. Microscopic examination showed that the tumor was an IPT.

Conclusion: Differential diagnosis between IPT and malignant neoplasms is difficult. Moreover, FDG-PET revealed strong uptake in the tumor. To our knowledge, this is the first patient reported to have an IPT in association with a rectal GIST. This patient is discussed along with a review of the literature.

Show MeSH
Related in: MedlinePlus