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Role of MR in the differentiation of IgG4-related from non-IgG4-related hepatic inflammatory pseudotumor

Hepatobiliary & Pancreatic Diseases International 2017年第6期16卷 631-637页

作者： Ruo-Fan Sheng Chang-Wen Zhai Yuan Ji Cai-Zhong Chen Li Yang Meng-Su Zeng Department of Radiology Zhongshan Hospital Fudan UniversityShanghai Institute of Medical ImagingNo. 180 Fenglin Road Xuhui District Shanghai 200032 China Department of Pathology Zhongshan Hospital Fudan UniversityShanghai Institute of Medical ImagingNo.180 Fenglin Road Xuhui District Shanghai 200032 China

BACKGROUND:Hepatic inflammatory pseudotumor(IPT)is classified into 2 types based on IgG 4 stain:IgG 4-related and non-IgG4-related; the two types differ not only in their pathological characteristics, but also in the clinical features. This study aimed to investigate the MR character of hepatic IPT,and differentiate the IgG4-related IPT from the non-IgG4-related ***:Twenty-five patients with 27 histologically proven hepatic IPTs were retrospectively analyzed. Ten lesions were diagnosed as IgG4-related IPT, and the other 17 as non-IgG4-related IPT. The MR signal features on T1,T2-weighted, dynamic-enhanced, and diffusion-weighted imaging were evaluated and compared. RESULTS:The dominant lesions were subcapsularly distributed(n=17, 63.0%) with clear boundary(n=20, 74.1%), and showed progressive enhancement pattern(n=21, 77.8%) with diffuse homogeneous(n=12, 44.4%) or heterogeneous(n=8,29.6%) hyperintensity, accompanied by delayed capsule-like enhancement(n=17, 63.0%) and central nonenhanced areas(n=18, 66.7%). Morphological features(P>0.05) were not sufficient to differentiate IgG4-related IPT from non-IgG4-related IPT; the wash-out pattern was only found in 2 IgG 4-related IPT, while the progressive enhancement pattern was more common in the non-IgG4-related lesions(n=16)(P=0.022).During portal and delayed phases, iso-/hypoenhanced lesions were only seen in 3 IgG4-related IPT, and circular-enhanced lesions(n=5) existed exceptionally in the non-IgG4-related group with significant differences(P=0.029 and 0.027). Most IgG4-related IPTs had lower apparent diffusion coefficient compared with the liver parenchyma(n=6), while most non-IgG4-related IPTs had higher apparent diffusion coefficient value(n=13)(P=0.046).CONCLUSIONS:Although MR images of hepatic IPT have certain characteristics, they are not enough to differentiate IgG4-related IPT from non-IgG4-related IPT. The enhancement pattern, signal features on portal and delayed phases, and the apparent diffusion c

关键词： liver inflammatory pseudotumor IgG4 magnetic resonance imaging

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Hilar inflammatory pseudotumor mimicking hilar cholangiocarcinoma

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Hepatobiliary & Pancreatic Diseases International 2010年第2期9卷 219-221页

作者： Deng, Fei-Tao Li, Yan-Xu Ye, Lun Tong, Ling Yang, Xiu-Ping Chai, Xin-Qun Huazhong Univ Sci & Technol Tongji Med Coll Union Hosp Dept Hepatobiliary Surg Wuhan 430022 Peoples R China Huazhong Univ Sci & Technol Tongji Med Coll Union Hosp Dept Pathol Wuhan 430022 Peoples R China

BACKGROUND: inflammatory pseudotumor of the biliary tract is a benign disease, and is extremely rare. Its diagnosis often depends on pathological examination after operation. The histopathological examination shows inflammatory lesions with a polymorphous infiltration and variable amounts of fibrous tissue. This study was undertaken to elucidate that an inflammatory pseudotumor in the right hepatic duct is especially difficult to distinguish from hilar cholangiocarcinoma. METHOD: The clinical data of one patient with inflammatory pseudotumor of the right hepatic duct were analyzed. RESULTS: An occupying lesion of the right hepatic duct was revealed by abdominal ultrasound and magnetic resonance cholangiopancreatography. The right hepatic duct inflammatory pseudotumor was not identified during the operation but was confirmed by postoperative histopathological analysis. The patient recovered well without any serious complication. CONCLUSIONS: The preoperative evaluation for optimizing surgical management is important to the diagnosis of hepatobiliary occupying lesions. The evaluation involves clinical manifestations, imaging appearance and tumor markers. Malignant tumors and possible benign lesions should be considered to avoid aggressive surgical treatment. (Hepatobiliary Pancreat Dis Int 2010; 9: 219-221)

关键词： inflammatory pseudotumor cholangiocarcinoma hepatic duct

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Relationship between dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor and paranasal sinusitis

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International Journal of Ophthalmology(English edition) 2016年第3期9卷 444-447页

作者： Jing Li Xin Ge Jian-Min Ma Beijing Tongren Eye Center Beijing Tongren HospitalCapital Medical UniversityBeijing Ophthalmology and Visual Sciences Key Laboratory

AIM：To determine the clinical features of the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor and its relationship with paranasal sinusitis.· METHODS：A retrospective analysis of 46 patients who received surgical treatment at the Department of Ophthalmology,Beijing Tongren Hospital,Capital Medical University for the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor from October 2010 to December *** patient underwent magnetic resonance imaging（MRI） of the orbits and the 4paranasal *** status and the level of serum immunoglobulin G4（IgG4） was measured before and6 mo after surgery.· RESULTS：The initial clinical feature of the idiopathic dacryoadenitis type of orbital inflammatory pseudotumor was redness or swelling of the *** were palpated in the area of the lacrimal gland in some *** the 46 patients,16 also suffered from sinusitis（34.8%）,with 14 cases of ethmoid sinusitis,8cases of maxillary sinusitis,9 cases of sphenoid sinusitis,and 8 cases of frontal *** the 16 patients with sinusitis,4 patients had a medical history of rhinitis（range：10mo to 15 y previously）,10 patients had occasional nasal congestion,and 2 patients had no nasal *** of the 46 patients had elevated serum IgG4 *** of these 13 patients had MRI signs of *** patients（n=46） received oral glucocorticoid treatment for approximately 3mo after *** sign of recurrence was found in the orbital MRI 6mo after *** the 16 patients with sinusitis,9cases of elevated serum IgG4 levels improved after treatment with decreased serum IgG4 level and 7 cases of normal serum IgG4 levels remained unchanged.· CONCLUSION：Some patients with the dacryoadenitis subtype of idiopathic orbital inflammatory pseudotumor may also suffer from paranasal *** incidence of paranasal sinusitis was much higher in patients with IgG4-elevated dacryoadenitis subtype orbital inflammatory pseudotumor than

关键词： orbital disease inflammatory pseudotumor sinusitis immtmoglobulin G4

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inflammatory pseudotumors in the liver associated with influenza:A case report

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World Journal of Hepatology 2023年第10期15卷 1164-1169页

作者： Ankoor Patel Alexander Chen Alexander T Lalos Department of Medicine Rutgers-Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States Department of Gastroenterology and Hepatology Rutgers-Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States

BACKGROUND inflammatory pseudotumor(IPT)is a rare and benign lesion that mimics malignancy and can develop in any part of the *** pathophysiology and etiology of these quasineoplastic lesions remain *** SUMMARY We report a case of a 65-year-old male who presented with fevers,night sweats,and unintentional weight loss following an influenza infection and was found to have multiple hepatic IPT’s following an extensive work *** Our case highlights the importance of considering hepatic IPT’s in the differential in a patient who presents with symptoms and imaging findings mimicking malignancy shortly following a viral infection.

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Infant biliary cirrhosis secondary to a biliary inflammatory myofibroblastic tumor: A case report and review of literature

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World Journal of Clinical Cases 2022年第23期10卷 8375-8383页

作者： Yuan Huang Sai-Nan Shu Hua Zhou Ling-Ling Liu Feng Fang Department of Pediatrics Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND A biliary inflammatory myofibroblastic tumor(IMT)is a rare type of mesenchymoma that,although it has a broad age spectrum,usually occurs in *** is difficult because biliary IMTs often exhibit nonspecific clinical symptoms and imaging features,resulting in delayed or inappropriate *** most IMTs are benign,some show malignant properties such as infiltration,recurrence,and *** SUMMARY Here,we retrospectively describe a 10-month-old infant who was admitted to our hospital due to stubborn *** patient responded poorly to routine medical treatment and his clinical manifestations and laboratory tests lacked specificity,so we turned to repeated ultrasound scans and other imaging *** both hepatosplenic ultrasonography and diffusion-weighted magnetic resonance imaging demonstrated a space-occupying lesion,an exploratory laparotomy was *** final diagnosis made over two mo after the disease onset was infant biliary cirrhosis caused by a biliary IMT,which partially infiltrated into the *** infant is the youngest case of biliary IMTs that has been reported till *** patient underwent an incomplete resection of the mass and Kasai ***,because of cirrhosis,he also received a paternal liver *** some IMTs show malignant properties,we proceeded with a three-year of follow-up;however,no recurrence or metastasis has been *** Neoplastic disease such as IMTs should be considered when routine medical treatment of obstructive jaundice is not *** of dynamic imaging changes is helpful for *** follow-up is necessary for IMTs.

关键词： inflammatory myofibroblastic tumor inflammatory pseudotumor Obstructive jaundice Biliary cirrhosis mesenchymoma Case report

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Pyogenic liver abscess as the first manifestation of hepatobiliary malignancy

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Hepatobiliary & Pancreatic Diseases International 2009年第5期8卷 547-550页

作者： Vui Heng Chong Kian Soon Lim Gastroenterology Unit Department of MedicineRaja Isteri Pengiran Anak Saleha(RIPAS)HospitalBandar Seri Begawan BA 1710Brunei Darussalam Gastroenterology Unit Department of RadiologyRaja Isteri Pengiran Anak Saleha(RIPAS)HospitalBandar Seri Begawan BA 1710Brunei Darussalam

BACKGROUND:Pyogenic liver abscess(PLA)is commonly seen in patients in the Far ***,hepatobiliary neoplasms are also *** as the initial manifestation of hepatobiliary neoplasms is extremely rare. METHOD:Three patients with PLA were identified from the ward registion files and were retrospectively reviewed. RESULTS:These patients(two men aged 74 and 80 years, and one woman aged 35 years)were treated(in the right lobe in two patients and in the left lobe in one)and subsequently followed up for 11-22 *** patients were diagnosed with hepatocellular carcinoma and one with metastatic *** patients were subjected to biopsies showing features of inflammatory pseudotumor before a diagnosis of hepatocellular *** patient underwent hepatic resection with good *** the other two patients who declined any further interventions,one died a few weeks after diagnosis and the other is still alive on conservative treatment. CONCLUSIONS:This series of cases highlights the importance of considering underlying hepatobiliary malignancies in patients with PLA and a close follow-up necessary for non-resolving hepatic lesions.

关键词： hepatocellular carcinoma cholangiocarcinoma infections inflammatory pseudotumor

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inflammatory myofibroblastic tumor of the right frontal lobe

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Chinese Neurosurgical Journal 2017年第3期3卷 184-187页

作者： Xuejian Wang Zhifeng Wang Yang Chen Ming Qian Department of Neurosurgery the Second Hospital affiliated to Nantong University Nantong University Nantong Jiangsu 226001 People's Republic of China

We aim to present an unique case of inflammatory myofibroblastic tumor (IMT) of the brain parenchyma and study the clinical presentation, imagine characteristic, intraoperative findings, and histopathology features of IMT in the brain parenchyma. A 36-year-old female with IMT come to see doctor presented with a 3-month history of progressively worsening weakness in the left upper limb along with alalia. Serial magnetic resonance imaging studies revealed a lesion within the right frontal lobe. The lesions were locally clear boundary with peripheral tissues. A right frontotemporal craniotomy was performed and the specimens were detected by immunohistochemical staining and light microscopy. Through the microscope, the tumor was composed of large number of chronic inflammatory cells and spindle cells. From immunohistochemical stains, it demonstrated CD34 (+), SMA (+), Vimentin (+), and actin (+) were positive meanwhile S-100(-) was negative. IMT of the right frontal lobe is a rare lesions. Surgical resection is the best and the most effective treatment.

关键词： inflammatory myofibroblastic tumor (IMT) inflammatory pseudotumor Therapy

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inflammatory Myofibroblastic Tumor of the Liver:A Diagnostic Challenge

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Journal of Clinical and Translational Hepatology 2014年第1期2卷 53-57页

作者： Gülsüm (O)zlem Elpek Department of Pathology Akdeniz University Medical School Antalya Turkey

inflammatory myofibroblastic tumor (IMT) is an uncommon myofibroblastic neoplasm that was formerly included within the broad category of inflammatory pseudotumor (IPT).IMT is rarely encountered in the *** to IMT of other organs,the interchangeable use of the terms IMT and IPT in liver has made the analysis of these lesions *** this review,clinical and pathological features of IMT of the liver are reviewed and the differential diagnosis of IMT is discussed,with emphasis on IPT and the other entities included in this large *** can mimic malignant *** are no known unique diagnostic clinical,laboratory,or radiological *** definitive diagnosis of IMT depends on careful pathological *** histopathological evaluation of hepatic IMT reveals that,the myxoid/vascular pattern is the most frequently observed,followed by,in decreasing frequency,fibrous histiocytomalike pattern and hypocellular fibrous *** IMT of the liver,anaplastic lymphoma kinase (ALK) expression reliably predicts the presence of an ALK gene *** diagnosis of hepatic IMT depends on the dominant histopathological pattern,and the management of the disease is still *** the liver is a distinctive neoplasm of intermediate biological potential,and should be distinguished from the variety of lesions that are included under the broad category of ***,to avoid confusion regarding the true incidence and behavior of hepatic IMT,the term IPT should not be used interchangeably with *** rarity of IMT in liver should not minimize its consideration in the differential diagnosis of liver tumors,especially in patients with tumor markers in normal range.

关键词： inflammatory myofibroblastic tumor Liver Anaplastic lymphoma kinase inflammatory pseudotumor

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