Seki Shuichi, Kitada Takuya, Sakaguchi Hiroki, Iwai Shuji, Hirohashi Kazuhiro, Higaki Ikko, Nakamura Kenji, Wakasa Kenichi, Kinoshita Hiroaki
Third Department of Internal Medicine, Osaka City University Medical School, Osaka, Japan.
Hepatogastroenterology. 2004 Jul-Aug;51(58):1140-3.
BACKGROUND/AIMS: Inflammatory pseudotumor of the liver is rare, and patients with inflammatory pseudotumor frequently undergo unnecessary surgical resection as a result of misdiagnosis of malignancy. In this study, we therefore investigated inflammatory pseudotumor clinicopathologically to clarify its characteristics.
Twenty patients including 3 with inflammatory pseudotumor and 17 with various malignant liver tumors were studied. We further investigated tumor vessels by means of immunohistochemistry using monoclonal antibodies against CD34, factor VIII-related antigen and alpha-smooth muscle actin.
Although serum levels of alkaline phosphatase were significantly higher in inflammatory pseudotumor patients than in other patients, the laboratory data alone could not precisely distinguish inflammatory pseudotumor from other hepatic tumors. On imaging studies such as ultrasonography and computed tomography, significant changes in tumor size, especially size reduction, during relatively short follow-up periods were often observed in inflammatory pseudotumor but not in other liver tumors. An enhancement of the peripheral regions of inflammatory pseudotumor was frequently observed in the early phase of contrast-medium dynamic computed tomography. This might be due to abnormal vessels located in the peripheral regions of inflammatory pseudotumor which might result from obliteration of some pre-existing vessels in portal tracts within inflammatory pseudotumor. Immunohistochemical analysis further revealed that abnormal vessels in the peripheral regions of inflammatory pseudotumor were positively stained with CD34, factor VIII-related antigen and alpha-smooth muscle actin as were tumor sinusoids within hepatocellular carcinoma and tumor capillaries in other malignant liver tumors.
Although inflammatory pseudotumor seems to have some features in imaging studies, a biopsy is needed for a correct diagnosis of inflammatory pseudotumor.
背景/目的：肝脏炎性假瘤较为罕见，炎性假瘤患者常因被误诊为恶性肿瘤而接受不必要的手术切除。因此，在本研究中，我们对炎性假瘤进行了临床病理研究以明确其特征。
对20例患者进行了研究，其中3例为炎性假瘤患者，17例为各种恶性肝脏肿瘤患者。我们使用抗CD34、VIII因子相关抗原和α-平滑肌肌动蛋白的单克隆抗体，通过免疫组织化学方法进一步研究肿瘤血管。
尽管炎性假瘤患者的血清碱性磷酸酶水平显著高于其他患者，但仅靠实验室数据无法准确区分炎性假瘤与其他肝脏肿瘤。在超声和计算机断层扫描等影像学检查中，炎性假瘤在相对较短的随访期内常出现肿瘤大小的显著变化，尤其是缩小，而其他肝脏肿瘤则未出现。在对比剂动态计算机断层扫描的早期阶段，常观察到炎性假瘤周边区域增强。这可能是由于炎性假瘤周边区域存在异常血管，这可能是炎性假瘤内门静脉区域一些原有血管闭塞所致。免疫组织化学分析进一步显示，炎性假瘤周边区域的异常血管与肝细胞癌内的肿瘤血窦及其他恶性肝脏肿瘤内的肿瘤毛细血管一样，均被CD34、VIII因子相关抗原和α-平滑肌肌动蛋白阳性染色。
尽管炎性假瘤在影像学检查中似乎有一些特征，但正确诊断炎性假瘤仍需要进行活检。
