Inflammatory pseudotumor of the liver with primary sclerosing cholangitis
Inflammatory pseudotumor of the liver with primary sclerosing cholangitis
复制标题
肝脏炎性假瘤伴原发性硬化性胆管炎
DOI：
10.1007/s005350050351
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发表时间：
2000
影响因子：
6.3
通讯作者：
H. Moriwaki
中科院分区：
文献类型：
--
作者：
K. Toda;I. Yasuda;Y. Nishigaki;M. Enya;Tetsuya Yamada;K. Nagura;J. Sugihara;T. Wakahara;E. Tomita;H. Moriwaki
肝脏炎性假瘤是一种罕见的良性肝脏肿块，其确切病因尚未阐明。我们报告一例原发性硬化性胆管炎（PSC）相关的IPT。患者男，50岁，因黄疸入院。腹部超音波及电脑断层检查显示肝内胆管多发性扩张及肝脏多发性肿块。在磁共振成像上，肿块在T1加权像上呈稍低信号，在T2加权像上呈稍高信号。Gd螯合剂团注后T1加权像上肿块无增强，动脉期和门静脉期呈低信号。然而，在延迟期，它们轻微增强，相对于周围正常肝实质几乎等信号。内视镜逆行性胆道造影显示肝内胆管有多处不规则狭窄及扩张。血管造影显示无异常发现，但有趣的是，随后的动态CO2增强超声显示强烈的高回声线，表明动脉已穿透低回声肿块。超声引导下经皮穿刺活检显示病变在形态上与IPT相当。在胆管造影和显微镜下分析肿瘤后，最终诊断确定为肝脏IPT伴PSC。以前的一些报告提出了一个可能的关系IPT和PSC，病理结果的基础上。该报告根据临床结果证实，PSC是肝脏IPT的原因之一。
Inflammatory pseudotumor (IPT) of the liver is a rare benign variant of hepatic masses, and its exact etiology has not been elucidated. We report a case of IPT associated with primary sclerosing cholangitis (PSC). The patient was a 50-year-old man admitted to our hospital because of jaundice. Abdominal ultrasonography (US) and computed tomography showed multiple dilations of the intrahepatic bile ducts and multiple masses in the liver. On magnetic resonance imaging, the masses were slightly hypointense on T1-weighted images and slightly hyperintense on T2-weighted images. On T1-weighted images after the bolus infusion of Gd chelate, the masses had no contrast enhancement, and they were hypointense in the arterial phase and portal venous phase. However, they were slightly enhanced and became almost isointense relative to the surrounding normal liver parenchyma in the delayed phase. Endoscopic retrograde cholangiography demonstrated multiple irregular strictures and dilations of the intrahepatic bile ducts. Angiography demonstrated no abnormal findings, but, interestingly, subsequent dynamic CO2-enhanced US showed a strongly hyperechoic string, indicating that an artery had penetrated through the hypoechoic mass. A US-guided percutaneous needle biopsy revealed that the lesions were morphologically comparable to IPT. After cholangiography and microscopic analysis of the tumor, the final diagnosis was determined to be IPT of the liver with PSC. A number of previous reports have suggested a possible relationship between IPT and PSC, based on pathological findings. This report confirmed, based on clinical findings, that PSC is one of the causes of hepatic IPT.