Hepatic Inflammatory Pseudotumor with Involvement of Diaphragm: Report of a Case

Inflammatory pseudotumors (IPT) of the liver are rare. We report a case of 62-yearold man with hepatic tumor presenting with right upper quadrant abdominal pain for 4 months. No fever or body weight loss was found. Abdominal ultrasonography and contrast-enhanced abdominal computed tomography showed a huge solitary tumor in the right lobe of the liver. Inflammatory pseudotumor was proved by core needle biopsy. Conservative management was chosen initially. Three months later, we found enlargement of this tumor with direct invasion into the diaphragm. Right hepatectomy and en bloc partial resection of the diaphragm was performed finally. No bacteria, fungus or mycobacterium was identified from microscopic examination and culture of pleural effusion above the diaphragm. Culture for the subphrenic ascites around the tumor revealed Escherichia coli & Bacteroides fragilis. Microscopic examination with Gram stain revealed gram-positive staphylococci in the diaphragm, which was infiltrated by tumor. Inflammatory pseudotumor is often introduced as a benign tumor. In this case, direct invasion into regional organs by such a tumor was noticed. After surveillance for 4 years after surgical operation, no recurrent hepatic tumor was found. We conclude that if invasive behavior of IPT is found or malignant hepatic tumor is suspected, surgical resection should be considered for patients who have acceptable liver reserve.