Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea.
J Hepatobiliary Pancreat Sci. 2012 Jul;19(4):405-12. doi: 10.1007/s00534-011-0436-z.
Inflammatory pseudotumor (IPT) of the liver is a benign condition with a good prognosis. However, it is difficult to distinguish clinical and radiological findings of IPT from those of malignancies. The aims of this study are to determine the clinical, radiological, and pathological characteristics, particularly relating to the role of the autoimmune mechanism in the development of inflammatory pseudotumours (IPTs) of the liver, and to suggest appropriate diagnostic and therapeutic strategy.
The clinical, diagnostic, and pathological characteristics including IgG4 immunohistochemical stain and follow-up data of 22 IPT patients were retrospectively analyzed.
The patients were 16 men and 6 women with a mean age of 59 years. Fifteen patients (68.2%) had associated biliary diseases. Of the 16 patients treated conservatively, the masses completely resolved in 10 patients, and reduced in size in 5 patients within the first 6 months. The remaining 6 patients were treated by surgical resection. IgG4 staining of 17 tissue samples from 22 patients were negative, most of the infiltrate being of fibrohistiocytic type, whereas 4 of 5 lymphoplasmacytic cells of dominant tumors show positive staining of IgG4. Although IgG4-related sclerosing cholangitis was mostly of lymphoplasmacytic type, other histological and clinical characteristics were similar in both types of IPTs.
IPTs of the liver can be diagnosed based on radiological and pathological findings by needle biopsy. Although the lymphoplasmacytic type of IPTs seems to correspond to IgG4-related disease, as assessed by IgG4 immunohistochemical stain, its clinical significance is unknown. Although most IPTs can be resolved with conservative therapy, surgical resection should be considered in cases of uncertain biopsy result, presumed malignant lesion, combination with other pathology, or lack of response to conservative management.
肝脏炎性假瘤（IPT）是一种预后良好的良性疾病。然而，其临床和影像学表现难以与恶性肿瘤相区别。本研究旨在确定其临床、影像学和病理学特征，尤其是与自身免疫机制在肝炎性假瘤（IPT）发病机制中的作用有关的特征，并提出适当的诊断和治疗策略。
回顾性分析了 22 例 IPT 患者的临床、诊断和病理学特征，包括 IgG4 免疫组化染色和随访资料。
患者为 16 男 6 女，平均年龄 59 岁。15 例（68.2%）存在相关胆道疾病。16 例接受保守治疗的患者中，10 例肿块完全消退，5 例在最初 6 个月内肿块缩小。其余 6 例患者接受了手术切除。22 例患者中有 17 例组织样本的 IgG4 染色为阴性，浸润细胞主要为纤维组织细胞型，而 5 例以淋巴浆细胞为主的肿瘤中有 4 例 IgG4 染色阳性。尽管 IgG4 相关硬化性胆管炎多为淋巴浆细胞型，但两种类型的 IPT 在组织学和临床特征上相似。
肝 IPT 可通过针吸活检基于影像学和病理学表现进行诊断。尽管 IPT 的淋巴浆细胞型似乎与 IgG4 相关疾病相对应，可通过 IgG4 免疫组化染色评估，但其临床意义尚不清楚。虽然大多数 IPT 可通过保守治疗缓解，但对于活检结果不确定、疑似恶性病变、合并其他病理改变或对保守治疗无反应的患者，应考虑手术切除。
