Purpose

Fibroinflammatory tumor is an uncommon neoplasm that was formerly included within the broad category of inflammatory pseudotumor. It is rarely encountered in the liver. Because of no known unique diagnostic clinical, laboratory, or radiological features, it is very difficult to distinguish between benign and malignant.

Methods

A 53-year-old man presenting with abdominal pain was referred to our hospital. Blood test showed normal complete blood cell count, differential count and increased serum total bilirubin (1.9 mg/dl), AST (165 U/L), ALT (294 U/L), ALP (716 U/L), γGT (955 U/L). Computed tomography revealed two common bile duct (CBD) stones, gallbladder stone and ill-defined low attenuated mass with heterogeneous enhancement in S7, sized 4.7 cm. 

Results

We first evaluated CBD with endoscopic retrograde cholangiopancreaticography (ERCP) and removed two stones with sphincterotomy. After ERCP, magnetic resonance imaging test was done. It revealed ill-defined lobulated/elongated mass like lesion, heterogeneously progressive enhancement, hyperemic change at perilesional parenchyma. Serum α-fetoprotein and carcinoembryonic antigen were within normal range, but cancer antigen 19-9 was elevated (42.0 U/mL). We cannot differentiated malignant tumor and decided to surgical resection. Histologic findings were fibroinflammatory lesion with heavy plasma cell infiltration, fibroblasts proliferation, cholestasis, portal vein intimal proliferation, hepatic artery narrowing and organization, sinusoidal congestion. Immunohistochemical stains were performed that IgG was positive but IgG4 was negative result.

Conclusion

Fibroinflammatory lesion of liver is a benign disease, and is extremely rare, especially difficult to distinguish from malignant tumor. The definitive diagnosis of it depends on careful pathological examination.