Inflammatory Pseudotumor of the Liver: Analysis of Seven Resected Cases

肝臟之發炎性假性腫瘤：七個手術切除病例的分析

陳怡如(Yi-Ju Chen) ； 吳誠中(Cheng-Chung Wu) ； 葉大成(Dah-Cheng Yeh) ； 鄭紹彬(Shao-Bin Cheng) ； 楊啟順(Chii-Shuenn Yen) ； 關寶祥(Po-Cheung Kwan)

《Formosan Journal of Surgery》 39卷3期 (2006/06) Pp. 139-146

https://doi.org/10.29833/FJS.200606.0005

摘要

肝臟的發炎性假性腫瘤是一種不常見的良性腫瘤，其發生原因尚未知，理論上可以不必手術切除。但它常被誤診為惡性肝腫瘤或肝膿瘍。從1989年9月到2004年6月，有1262名病人在醫院接受肝臟腫瘤切除手術，其中有7個病人的病理診斷為肝臟的發炎性假性腫瘤。幾乎病人之腫瘤標記皆為陰性，所有病人在超音波下皆有一邊緣不清楚之低回音腫瘤；電腦斷層攝影則顯現低濃度區及高增強邊緣。吾人結論：若病人無B型或C型肝炎感染且腫瘤標誌皆為陰性，而肝臟超音波呈現無明顯邊緣之低迴音病變，電腦段層攝影呈現低密度且其邊緣有高增強影像時，我們可懷疑是發炎性假性腫瘤，此時可在超音波底下進行肝臟穿刺檢查，給予保守性療法，並以影像學檢查觀察直到腫瘤變小或消失，可避免不必要的手術。

並列摘要

Objectives: Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion which is commonly misdiagnosed as malignant tumor or liver abscess. Surgery is generally unnecessary because of its benign course. The purpose of this study is to determine non-surgical treatment options for IPT.
Patients and Methods: Among 1262 patients who underwent liver resection for tumors from September 1989 to June 2004, seven patients had pathologically confirmed IPT of the liver. All the seven patients background characteristics, pathologic findings of the tumor, as well as early and late results were reviewed and analyzed.
Results: The liver function tests were all within normal range with a normal serum α-fetoprotein (AFP) and carcinoembryonic antigen (CEA). Abdominal ultrasonography showed all tumors as hypoechoic lesions with unclear margin. Enhanced computed tomography (CT) scans showed a low-density area with marginal enhancement in six patients. One patient had liver cirrhosis. No complications occurred in any patient after surgery. All patients survived, with the longest survival time to date being 14 years.
Conclusions: In patients with or without positive hepatitis seromarkers and normal tumor markers, if abdominal ultrasonography shows hypoechoic lesions with unclear margin and CT scan shows a low-density area with marginal enhancement, IPT of the liver could be suspected. If percutaneous liver needle biopsy confirms the diagnosis of IPT of the liver, surgery can be avoided.

並列關鍵字

inflammatory pseudotumor ； benign liver tumor