Fact-sheet: Inflammatory pseudotumour of the liver
Updated on 09/12/2019 at 11:50 AM
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Definition
Rare benign lesion defined by the World Health Organization (WHO) as a benign, non-neoplastic, non-metastatic mass.
Male predominance.
Most often solitary (81%), more rarely multiple, usually intrahepatic but may also be located in the hilum.
The origin remains unknown but could correspond to a xanthogranulomatous inflammatory response to an initial infection occurring in a background of chronic inflammation.
Some inflammatory pseudotumors are probably the residue of a healed hepatic abscess, while others have been reported following EBV infection.
Clinical features
Asymptomatic unless complicated (portal branch thrombosis, rare)
Laboratory findings
Mild cholestasis/hepatic cytolysis
MRI
Lesions usually iso- or hypointense on T1, iso- or hyperintense on T2; enhancement after gadolinium injection is moderate, usually peripheral, most often associated with central areas of necrosis. In most cases (80%) there is only a single mass in the right lobe.
Numerous atypical presentations have been described:
- multiple masses, hypervascular lesions
- lesions with capsular retraction
- multicystic form with extensive necrosis resembling an abscess
Management
Preoperative diagnosis is difficult given the extremely heterogeneous imaging presentation of this condition
Value of follow-up imaging demonstrating spontaneous regression of the lesion in order to avoid unnecessary intervention
Differential diagnosis
Imaging findings are nonspecific, and the main differential diagnoses include:
- cystic lesions such as alveolar echinococcosis or hepatic abscesses
- malignant necrotic tissue lesions such as HCC, cholangiocarcinoma, or hepatic metastases
