Inflammatory Pseudotumor in the Spiegel Lobe of the Liver of an Elderly Woman

Abstract

We describe an inflammatory tumor in the Spiegel lobe of the liver of an 81-year-old woman. The patient was referred to our hospital for evaluation of a fever of over 39°C and upper abdominal pain. Both conditions had persisted for five days in spite of antibiotic treatment. Initial laboratory tests revealed a serum C-reactive protein concentration of 20.9 mg/dL and white blood cell count of 15,500/μL. Abdominal ultrasound showed a hypoechoic lesion measuring 4 cm in diameter in the Spiegel lobe of the liver. A follow-up abdominal ultrasound revealed that the hypoechoic lesion was not decreased in size. Computed tomography showed a moderate-to-high-density area in the arterial phase and a low-density area in the Spiegel lobe on delayed phase. Magnetic resonance imaging showed a faint low-intensity lesion on T1-weighted imaging and moderate-to-high-intensity lesion on T2-weighted imaging in the Spiegel lobe. Angiography showed a slight hypervascularity in the area of the Spiegel lobe. Antibiotics and ν-globulin were commenced soon after admission and the fever gradually improved. Ultrasound-guided liver biopsy revealed that the hepatic parenchyma was almost completely replaced by dense hyalinized fibrous tissue and inflammatory cells. These findings were construed to indicate a benign lesion, but the tumor remained unchanged. Malignant disease could not be completely ruled out. Segment 1 of the liver was resected. Macroscopic examination of the resected specimen revealed a gray, fibrotic, solid tumor. The border of the tumor was well-circumscribed but not encapsulated. Microscopically, the tumor showed a marked fibrotic background with infiltration by a mixed population of lymphocytes, plasma cells, histiocytes, and reactive, plump spindle cells. The postoperative course was uneventful. The patient has remained well in the 10 months since the resection without recurrence.