University of Texas Health San Antonio San Antonio, TX
Christopher J. Cieker, MD1, Aaron Jabir, MD1, Brian Lee, DO1, Carlos Bouchot, MD1, Lisa D. Pedicone, PhD2, Fabian Rodas, MD1, Andres Gomez-Aldana, MD2, Eugenia Tsai, MD3, Eric Lawitz, MD3, Carmen Landaverde, MD2, Fred Poordad, MD1, Jan Petrasek, MD, PhD2 1University of Texas Health San Antonio, San Antonio, TX; 2Texas Liver Institute, Austin, TX; 3Texas Liver Institute, San Antonio, TX Introduction: Inflammatory pseudotumors of the liver (IPTL) are non-malignant collections of myofibroblastic spindle and inflammatory cells that can mimic malignancies.1 They represent 0.7% of all liver masses.1 We present a case in which suspected metastatic cholangiocarcinoma was found to be IPTL.
Case Description/
Methods: A 22-year-old female with a 6-month history of choledochocele and alcohol abuse presented with two months of abdominal pain, fevers, and anorexia. Surgical history includes cholecystectomy, hepaticojejunostomy, and a percutaneous transhepatic cholangiography (PTC) drain for management of choledochocoele complicated by recurrent cholangitis. Liver labs noted AST 99 U/L, ALT 71 U/L, ALP 878 U/L, Tbili 0.6 mg/dL, and INR 1.2. Viral and serological causes of liver injury were negative. A liver abscess was found in the caudate lobe/segment I and managed with antibiotics. A CT and MRI with and without contrast found an 8.5 cm lesion (Figure 1) at the hepatic hilum and a 2.1 cm satellite lesion.
The patient was referred to a multidisciplinary tumor board which led to a liver and lymph node biopsy. Pathology revealed benign-appearing cells associated with inflammation (Figure 1). This favored IPTL due to infection. Management included levofloxacin + metronidazole. Four weeks later, the main lesion decreased to 5.8 cm on imaging. Discussion: The mechanism behind IPTLs is unknown.1,2,3 Possible etiologies are infection, autoimmune disease, trauma, surgery, or chronic biliary obstructions.1,2,3 They are difficult to diagnose given the non-specific symptoms and malignant appearance.1,2 No standard treatment exists, but strategies can include anti-inflammatories, antibiotics, or surgery.1,2,3
This case demonstrates that accurate diagnosis of IPTLs is crucial because it can alter treatment from aggressive medical or surgical intervention to conservative management.
References
1. Barabino M, Piccolo G, Tramacere A, et al. Inflammatory Pseudotumor of the Liver or Intrahepatic Cholangiocarcinoma, That's the Question: A Review of the Literature. Cancers (Basel). 2024 Aug 23;16(17):2926.
2. You Y, Shao H, Bui K, et al. Epstein-Barr virus positive inflammatory pseudotumor of the liver: report of a challenging case and review of the literature. Ann Clin Lab Sci. 2014 Fall;44(4):489-98.
3. Bae SK, Abiru S, Kamohara Y, et al. Hepatic inflammatory pseudotumor associated with xanthogranulomatous cholangitis mimicking cholangiocarcinoma. Intern Med. 2015;54(7):771-5.
Figure: Figure 1. (A) Initial MRI liver with and without contrast illustrating 8.5 cm maximum lobulated hepatic pseudotumor prior to initiation of antibiotic therapy. (B) Initial CT liver with and without contrast illustrating lobulated hepatic pseudotumor prior to initiation of antibiotic therapy. (C) Blue arrow (right) illustrates normal liver histology and orange arrow (left) illustrates sclerosis with mixed inflammatory cells at 4x magnification. (D) Sclerosis with trickling inflammatory infiltrate at 20x magnification.
Disclosures: Christopher Cieker indicated no relevant financial relationships. Aaron Jabir indicated no relevant financial relationships. Brian Lee indicated no relevant financial relationships. Carlos Bouchot indicated no relevant financial relationships. Lisa D. Pedicone indicated no relevant financial relationships. Fabian Rodas indicated no relevant financial relationships. Andres Gomez-Aldana indicated no relevant financial relationships. Eugenia Tsai indicated no relevant financial relationships. Eric Lawitz: 89 Bio INC – Consultant, Grant/Research Support, Speakers Bureau. Abbvie – Speakers Bureau. Akero Therapeitics – Grant/Research Support. Alnylam Phamaceuticals INC – Grant/Research Support. Amgen – Grant/Research Support. Aztrazeneca – Consultant, Grant/Research Support. Bioscience – Grant/Research Support. Boehringer Ingelheim – Consultant, Grant/Research Support. Bristol-Myers Squibb – Grant/Research Support. Corcept Therapeutics – Consultant, Grant/Research Support. Cour Pharmaceuticals Inc – Grant/Research Support. Cymabay Therapeutics – Grant/Research Support. Eli Lily and Company – Consultant, Grant/Research Support. Enanta Pharmaceuticals – Grant/Research Support. Enyo Pharma – Grant/Research Support. Exalenz – Grant/Research Support. Galectin Therapeutics – Grant/Research Support. Galmed Pharmaceuticals – Grant/Research Support. Genfit – Grant/Research Support. Gilead Sciences – Grant/Research Support, Speakers Bureau. GlaxoSmithKline – Grant/Research Support. Hanmi Pharmaceuticals – Grant/Research Support. Hightide Biopharma – Grant/Research Support. Intercept Pharmaceuticals – Grant/Research Support, Speakers Bureau. Inventiva – Grant/Research Support. Ipsen – Grant/Research Support. Jansen Pharmaceuticals – Grant/Research Support. Madrigal Pharmaceuticals – Grant/Research Support, Speakers Bureau. Merck & Co – Consultant, Grant/Research Support. NGM Biopharmaceuticals Inc – Grant/Research Support. Northsea Therapeutics – Grant/Research Support. Novartis – Grant/Research Support. Novo Nordisk Inc – Consultant, Grant/Research Support. Organovo – Consultant, Grant/Research Support. Poxel Co – Grant/Research Support. Regeneron – Consultant, Grant/Research Support. Sagimet Biosciences – Consultant, Grant/Research Support. Takeda – Grant/Research Support. Terns pharmaceuticals – Grant/Research Support. Viking Therapeutics – Grant/Research Support. Zydus Pharmaceuticals – Grant/Research Support. Carmen Landaverde indicated no relevant financial relationships. Fred Poordad indicated no relevant financial relationships. Jan Petrasek indicated no relevant financial relationships.
Christopher J. Cieker, MD1, Aaron Jabir, MD1, Brian Lee, DO1, Carlos Bouchot, MD1, Lisa D. Pedicone, PhD2, Fabian Rodas, MD1, Andres Gomez-Aldana, MD2, Eugenia Tsai, MD3, Eric Lawitz, MD3, Carmen Landaverde, MD2, Fred Poordad, MD1, Jan Petrasek, MD, PhD2. P1706 - Inflammation Situation: Inflammatory Pseudotumors of the Liver, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
