Lee Joo Hyung, Kim Hyung Sun, Kim Ji Sub, Lee Dong Ki, Lim Jin Hong
Department of Surgery Pancreatobiliary Cancer Clinic, Department of Surgery Department of Pathology Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, Korea.
Medicine (Baltimore). 2018 Jun;97(24):e11146. doi: 10.1097/MD.0000000000011146.
Immunoglobulin (Ig)G4-related pseudotumors of the liver are very rare diseases that are difficult to distinguish from malignant tumors. They can be usually improved by steroid therapy. Actinomycosis is a chronic, suppurative, granulomatous infection, for which immune suppression is a predisposing factor. It can also mimic malignant tumors.
A 67-year-old man presented with mild abdominal discomfort and a 5-kg weight loss for 3 months. Initially, he visited another hospital and was treated with antibiotics under the assumption of a liver abscess. Symptom was not resolved.
He diagnosed as having an IgG4-related pseudotumor of the right lobe of the liver after liver biopsy. Despite 2 months of steroid therapy, the liver mass was aggravated and invaded the right lung, as observed on follow-up computed tomography scan.
We performed en bloc resection of the tumor under the assumption that it was a malignant tumor.
The pathology of the tumor was revealed as actinomycotic colonies and IgG4-positive plasma cells of the liver. He recovered well and was discharged with ursodeoxycholic acid tablet for 14 days. After 3 months, he underwent postoperative follow-up CT and there was no remarkable finding in remnant left hepatic lobe.
Hepatic actinomycosis and IgG4-related pseudotumors of the liver are both difficult to diagnose. As in our patient, combined diseases are more difficult to diagnose and to determine the optimal treatment. Since immunosuppression therapy of autoimmune diseases can cause and aggravate infection, management must be approached carefully. We can learn that various possibilities must be considered before diagnosing and treating a hepatic mass.
肝脏免疫球蛋白（Ig）G4相关假性肿瘤是非常罕见的疾病，很难与恶性肿瘤区分开来。它们通常可以通过类固醇治疗得到改善。放线菌病是一种慢性、化脓性、肉芽肿性感染，免疫抑制是其诱发因素。它也可能酷似恶性肿瘤。
一名67岁男性，出现轻度腹部不适并体重减轻5公斤，持续3个月。最初，他前往另一家医院就诊，因疑似肝脓肿接受抗生素治疗。症状未缓解。
肝脏活检后，他被诊断为右叶肝脏IgG4相关假性肿瘤。尽管进行了2个月的类固醇治疗，但在后续的计算机断层扫描中发现肝脏肿块增大并侵犯了右肺。
我们在假定肿瘤为恶性肿瘤的情况下对其进行了整块切除。
肿瘤病理显示为肝脏的放线菌菌落和IgG4阳性浆细胞。他恢复良好，出院时带熊去氧胆酸片服用14天。3个月后，他接受了术后随访CT检查，左肝叶残余部分未发现明显异常。
肝放线菌病和肝脏IgG4相关假性肿瘤都难以诊断。正如我们的患者一样，合并疾病更难诊断和确定最佳治疗方案。由于自身免疫性疾病的免疫抑制治疗可导致并加重感染，因此必须谨慎处理。我们可以了解到，在诊断和治疗肝脏肿块之前必须考虑各种可能性。
