Hamano Ai, Yamada Reiko, Kurata Kazunari, Tsuboi Junya, Inoue Hiroyuki, Tanaka Kyosuke, Horiki Noriyuki, Takei Yoshiyuki
Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Endoscopy, Mie University Graduate School of Medicine, Tsu, Japan.
Clin J Gastroenterol. 2021 Feb;14(1):263-268. doi: 10.1007/s12328-020-01245-x. Epub 2020 Oct 9.
A 71-year-old man on prednisolone for immunoglobulin (Ig) G4-related renal disease showed increased carbohydrate antigen (CA) 19-9 level; abdominal enhanced computed tomography (CT) showed a lesion in the left lateral segment and dilatation of the peripheral biliary duct. He was referred to our hospital for detailed examination for suspected intrahepatic cholangiocarcinoma. CT and magnetic resonance imaging findings were similar to those for intrahepatic cholangiocarcinoma. However, endoscopic retrograde cholangiopancreatography showed a smooth narrowing of the bile duct which suggested inflammatory disease. Liver biopsy was performed; IgG4-related hepatic inflammatory pseudotumor (IPT) was diagnosed. IgG4-related hepatic IPTs are rare diseases that develop in association with the development of sclerosing cholangitis. Most of these lesions develop in the hepatic hilum and the imaging findings of these tumors are similar to those of hilar cholangiocarcinomas. Thus, hepatic IPTs are difficult to differentiate from malignancy; in some cases, surgical resection has been considered for establishing the diagnosis. In the present case, we could diagnose hepatic IPT on the basis of liver biopsy, which is the recommended approach in cases of suspected hepatic IPT.
一名因免疫球蛋白（Ig）G4相关性肾病而服用泼尼松龙的71岁男性，其糖类抗原（CA）19-9水平升高；腹部增强计算机断层扫描（CT）显示左外侧段有一个病变，周围胆管扩张。他因疑似肝内胆管癌被转诊至我院进行详细检查。CT和磁共振成像结果与肝内胆管癌相似。然而，内镜逆行胰胆管造影显示胆管呈光滑狭窄，提示为炎症性疾病。进行了肝脏活检；诊断为IgG4相关性肝脏炎性假瘤（IPT）。IgG4相关性肝脏IPT是与硬化性胆管炎相关的罕见疾病。这些病变大多发生在肝门部，这些肿瘤的影像学表现与肝门部胆管癌相似。因此，肝脏IPT难以与恶性肿瘤区分；在某些情况下，为明确诊断考虑进行手术切除。在本病例中，我们能够根据肝脏活检诊断肝脏IPT，这是疑似肝脏IPT病例的推荐方法。
