Multifocal inflammatory pseudotumor of the liver

Inflammatory pseudotumor of the liver is a rare entity of unknown etiology; fewer than 80 cases have been reported in the world literature. Its appearance on the computerized tomography, ultrasound and magnetic resonance have been previously described as nonspecific, and clinical presentation is not helpful in the diagnosis. This is why the diagnosis usually is made after laparotomy and often after the excision of the tumor. Several recent reports show that drug therapy is effective and lead to tumor regression, while other authors believe that an aggressive approach should be taken, due to the potential adverse impact of its vascular invasive and biliary obstructive nature. Herein we describe a case of this clinical entity, which occurred in a 52 years old patient, where the operative examination showed bilobar involvement, treated with right hepatectomy and contra-lateral tumor excision in the clinical suspect of hepatocellular carcinoma. The detailed clinical, radiological and pathological picture is described. At 6 months follow-up the patient conditions are excellent. On the basis of the available literature, we discuss the clinical features and the therapeutical problems of such rare clinical entity, and propose a selected use of liver biopsy when the clinical suspicion of pseudotumor can be considered, in order to achieve a preoperative diagnosis and therefore to avoid surgery.