Abstract
A 65-year-old man was admitted to the hospital because of fever. The laboratory findings revealed leukocytosis (20,600/μl), an elevation of C-reactive protein level (34.57 mg/dl), and an increase in alkaline phosphatase level (729 IU/l). Enhanced computed tomography showed hepatotorophy of the left lobe, an intrahepatic bile duct stone in the left hepatic duct, and a multicystic lesion 6 cm diameter in segment 1 of the liver. MRI showed a lesion of low signal intensity in T1 weighted images and a lesion of moderate-to-high signal intensity accompanied with strongly high signal intensity on T2 weighted images. Endoscopic retrograde cholangiopancreatography demonstrated bile duct stenosis in the left hepatic duct and bile duct dilatation in the left lobe. Enhanced computed tomography after antibiotic therapy revealed a decrease in tumor size to 4 cm in diameter. Based on these findings, the tumor was suspected to be an inflammatory pseudotumor of the liver. Because of the hepatotorophy associated with hepatolithiasis, a left lobectomy and a caudal lobectomy were performed. The cut surface of the lesion of the liver mostly consisted of a whitish area accompanied with a yellowish and translucent area. Microscopic examination of the tumor showed proliferation of spindle-like cells, infiltration of macrophages and lymphocyte, and no evidence of malignancy. The patient was given a diagnosis of inflammatory pseudotumor of the liver due to segmental cholangitis associated with hepatolithiasis.
