Pseudotumor inflamatorio hepático, una entidad de difícil diagnóstico / Inflammatory pseudotumor of the liver: a condition hard to diagnose

RESUMEN El pseudotumor inflamatorio hepático es una lesión muy infrecuente, sin una etiología ni patogenia claras. Su diagnóstico preoperatorio no es habitual pero, en caso de realizarse, puede evitar la cirugía. Presentamos el caso de un paciente joven, con antecedente de lupus cutáneo que, tras debutar con una pancreatitis aguda, presenta episodios de colangitis y cuyos hallazgos radiológicos no permiten descartar la presencia de un colangiocarcinoma, por lo que se realiza hepatectomía izquierda, siendo el diagnóstico histológico final de pseudotumor inflamatorio hepático.

ABSTRACT Inflammatory pseudotumors of the liver are rare and lack clear etiology and pathogenesis. The preoperative diagnosis is seldom made but it avoids unnecessary surgery. We report the case of a young male patient with a history of cutaneous lupus and episodes cholangitis after an acute pancreatitis. As the imaging tests could not rule out cholangiocarcinoma, a left liver resection was performed, and the final histologic diagnosis was inflammatory pseudotumor of the liver.

Pseudotumor inflamatorio nasosinusal: reporte de un caso / Inflammatory pseudotumor sinonasal: a case report / Pseu-dotumor inflamatório nasossinusal: relatório de um caso

El pseudotumor inflamatorio (PTI) es una entidad no neoplásica, de etiología desconocida, caracterizada por la proliferación de un infiltrado inflamatorio policlonal sobre un estroma de tejido conjuntivo. Pueden ser definidos como lesiones que clínica y radiológicamente simulan neoplasias. El pseudotumor inflamatorio puede causar dolor facial, obstrucción nasal, exoftalmos y discapacidad visual y con frecuencia causa la erosión y destrucción ósea. Los corticoesteroides, la radioterapia y la cirugía se han utilizado como modalidades de tratamiento, solos o en combinación.

The inflammatory pseudotumour (IPT) is a nonneoplastic entity of unknown origin, and is characterised by a proliferation of connective tissue and a polyclonal inflammatory infiltrate. May be defined as lesions that clinically and radiologically simulate neoplasms. Inflammatory pseudotumour sometimes causes facial pain, nasal obstruction, exophthalmos and visual impairment, and often causes bone erosion and destruction. Corticosteroids, radiotherapy and surgery have been used as treatment modalities either on their own or in combination.

O pseudo-tumor inflamatório (PTI) é uma entidade não neoplásica de etiologia desconhecida, caracterizada pela proliferação de um infiltrado inflamatório policlonal em um estroma do tecido conjuntivo. Podem ser definidos como lesões que simulam neoplasias clínica e radiologicamente. O pseudo-tumor Inflamatório pode causar dor facial, obstrução nasal, exoftalmia (olhos saltados), deficiência visual e freqüentemente provoca o desgaste e a destruição óssea. Os cortiçoesteroides, a radioterapia e a cirurgia têm sido usadas como modalidades de tratamento, por si só ou em combinação.

Tumor miofibroblástico inflamatorio (pseudotumor inflamatorio) ocasionando abdomen agudo / Inflammatory myofibroblastic tumor as a cause of acute abdomen

Background: Inflammatory myofibroblastic tumor (IMT) is a rare disease, usually benign, although with possible progression to malignancy. The clinical features depend on its location. If the resection is completed, surgery is curative, but recurrence is possible. The diagnosis is always histopathological. Case report: We report a 20 years old female admitted for a progressive abdominal pain lasting 24 hours. The patient was subjected to an appendectomy but in the postoperative period she continued with nausea and vomiting. The patient was operated again, finding a small bowel tumor with multiple adhesions, occluding the intestinal lumen and a Meckel diverticulum. The pathological study of the tumor reported the presence of an inflammatory myofibroblastic tumor. The patient had an uneventful postoperative outcome.

Introducción: El tumor miofibroblástico inflamatorio (TMI) es una enfermedad poco frecuente, en general benigna, aunque con posible evolución a malignidad. Las características clínicas dependen del lugar en el que esté ubicado. La cirugía es curativa siempre y cuando la resección sea total; aunque no se excluye la posibilidad de recidivas. El diagnóstico siempre es histopatológico. Dadas sus características clínicas y sitios de presentación se ha denominado de distintas formas e incluso sigue siendo motivo de estudio a fin de entender completamente su fisiopatología. Caso clínico: Presentamos un caso de esta rara entidad con un cuadro clínico de un abdomen agudo.

Pseudotumor inflamatorio del hígado: recurrencia después de la resección / [Inflammatory pseudotumor of the liver: a case of recurrence after resection].

Inflammatory pseudo-tumor of the liver is a rare benign condition. Usually presented as a large liver mass, may cause obstruction or infiltration of the main vessels or biliary tree. The clinical presentation is mostly an inflammatory syndrome with acute abdominal pain. We present a 39-year-old female patient with abdominal pain, fever and jaundice. Images showed a 15-cm liver lesion in the left lobe of the liver. Malignancy could not be discarded and the patient underwent left hepatectomy. The histologic examination reported an inflammatory pseudo-tumor of the liver. The patient recurred after one year with the same symptoms and a 10-cm new lesion occupying segment I. Considered as a recurrence, medical treatment was decided tumor size decreased 50

after the first month and completely disappeared during the follow up. Two years later, the patient was readmitted with a new episode and a new 8-cm liver lesion in segment VII. She was treated again with anti-inflammatory medication and imaging control. Although inflammatory pseudo-tumor of the liver is a benign condition, it can have a recurrent behaviour. The differentiation with other malignant tumors sometimes is impossible by clinical and imaging presentation.

Seudotumor inflamatorio pulmonar: presentación de 2 casos y revisión de la literatura / Pulmonary inflammatory pseudotumour: two case report and review of theliterature

Primary lung tumours in children are rare, the most common lesions seen in clinical practice are metastatic disease. The majority of children who present with a primary or secondary pulmonary malignancy will present coincidentally while seeking attention for another medical problem, or with non-specific abnormalities such as cough with collapse or consolidation on the chest x-ray. Primary malignant tumours of the lung are the most common, this group is made up of carcinoid tumours, bronchogenic carcinoma and pleuropulmonary blastoma. Benign primary pulmonary tumours are inflammatory pseudotumour or plasma cell granuloma and hamartoma. Often, the possibility of a primary or secundary pulmonary tumour is considered only when radiographic abnormalities or symptoms persist or fail to respond to therapy, many children are asymptomatic until they have advanced disease, which delays diagnosis even further. The aim of this article is show our experience of two patients with inflammatory pseudotumour and literature review.

Los tumores pulmonares primarios en niños son muy poco frecuentes, siendo más reportadas las lesiones metátasicas. La mayoría de los pacientes que presentan un tumor pulmonar ya sea primario o secundario, son hallazgos de algún examen generalmente imagenológico, como parte del estudio de otras causas o en presencia de síntomas inespecíficos como tos asociada a atelectasia o condensación. Los tumores pulmonares primarios malignos son los más frecuentes, comprenden el tumor carcinoide, carcinoma broncogénico y blastoma pleuropulmonar. Los tumores pulmonares primarios benignos son el seudotumor inflamatorio (sTi) o granuloma de células plasmáticas y el hamartoma. Se debe tener un alto índice de sospecha en el diagnóstico de tumor pulmonar primario o secundario, frente a la persistencia de síntomas o si presenta una lesión en la radiografía de tórax que no se modifica o invade localmente a otros tejidos adyacentes a pesar del tratamiento. El objetivo de este artículo es mostrar nuestra experiencia de 2 pacientes portadores de sTi y hacer una revisión de la literatura.

Inflammatory pseudotumor of the omentum.

Inflammatory pseudotumor is an unusual quasineoplastic lesion, of uncertain natural history and etiopathogenesis, which consists of inflammatory cells and myofibroblastic spindle cells; and is usually found in children and young adults. Clinical manifestations and radiological feature of this rare entity, can be indistinguishable from a malignant sarcomatous or lymphoproliferative disorders. Here, a case of surgically proven inflammatory pseudotumor of the omentum in a child and its review of literature is presented. Conservative surgery is curative in most cases of inflammatory pseudotumors. Awareness of this lesion is essential for clinicians, radiologists and pathologists, as pre-operative recognition may spare the child from unnecessary radical surgery or harmful chemoradiotherapy.

Tumor miofibroblástico inflamatorio de arteria carótida interna resecado con embolización selectiva previa: reporte de caso / Inflammatory myofibroblastic tumor related to the internal carotid artery, extirpated after an arterial selective embolization

El tumor miofibroblástico inflamatorio es una lesión infrecuente, cuya importancia radica en ser diagnóstico diferencial de otras neoplasias. Se le ha relacionado con Infecciones, traumas, cirugías previas e ínmunosupresión, pero se cree que éstos sólo serían el evento ínidal que daría lugar a una serie de cascadas autoinmunes que perpetuarían al cuadro. Afecta a población infantil y adulta joven, con una edad media de aparición de 10 años, sin distinción de género. A continuación se presenta el caso de una mujer de 45 años de edad con diagnóstico de tumor miofibroblástico inflamatorio de arteria carótida interna, resecado con embolización arterial selectiva previa. Además, se revisa la literatura al respecto.

The inflammatory myofibroblastic tumor is a rare condition, and its' relevant for being a differential diagnosis of many other neoplasms. It has been related with different infections, traumas, previous surgeries and immune deficiencies, but there are studies that support the theory that these factors are only the initial event of an autoimmune reaction that perpetuates the disease. It affects childs and young adults, with an average of 10 years old at the moment of presentation, without differences between genre. In this case, we reporta 45 year old woman, with an histological diagnosis of inflammatory myofibroblastic tumor related to the internal carotid artery, extirpated after an arterial selective embolization. Besides, we review the literature.

[Inflammatory pseudo tumors of the paratesticular tissue, a case report]

Inflammatory pseudo tumors of the paratesticular tissue are uncommon lesions. They are often reported in the literature by various terms. These lesions are clinically worry some evoking a malignant testicular tumor. We describe a 57-year-old man with a long time history of painless scrotal mass that encased the left testis. Once excised, histology showed fibrosis and inflammatory tissue with lymphoplasmacytic cells

Un nuevo caso de pseudotumor inflamatorio de la tráquea / A new case of inflammatory tracheal tumor

El pseudotumor inflamatorio de tráquea es poco frecuente y puede simular un tumor cuando se localiza en la luz traqueal o bronquial. El objetivo del presente artículo fue presentar un nuevo caso y revisar la literatura especializada. Se trató de una paciente de 23 años de edad, con cuadro de disnea de varios años de evolución, tratada con el diagnóstico de asma bronquial. Fue intervenida de urgencia por empeoramiento de la disnea y diagnóstico de tumor intratraqueal, según estudio broncoscópico. Se practicó la resección de 5 anillos traqueales con anastomosis término-terminal. La evolución posoperatoria fue satisfactoria y la paciente se encuentra libre de recidiva 5 años después de la operación(AU)

The inflammatory tracheal pseudotumor is rare and it may mimic a tumor when it is located in the tracheal or bronchial light. The objective of this article was to present a new case and to review the specialized literature. The case of a 23-year-old patient with a picture of dyspnea of several years of evolution treated with diagnosis of bronchial asthma was reported. She underwent emergency surgery due the worsening of dypsnea and to the diagnosis of intratracheal tumor according to a bronchoscopic study. The resection of 5 tracheal rings was performed with termino-terminal anastomosis. The postoperative evolution was satisfactory and the patient has been free of relapse five years after the operation(AU)

Idiopathic inflammatory pseudotumor of the carotid sheath

We present a biopsy proven case of 47 years-old man with a carotid pseudotumor, clinically presented as carotidynia. CT showed a mass encasing and narrowing the common carotid artery and MRI showed hypointense signal in T2 and intense enhancement after contrast media administration. The patient was suspected to have an inflammatory process and steroids were prescribed. Eight days after the steroid treatment significant radiological and clinical improvement was observed. The patient remains free of symptoms.

Apresentamos um caso comprovado por biópsia de pseudotumor carotídeo em um homem de 47 anos, com apresentação clínica de carotidinia. A TC mostrou massa envolvendo e estenosando a artéria carótida comum direita e a RM apresentava lesão com hipossinal em T2 e importante realce com o uso de meio de contraste paramagnético. O paciente recebeu a hipótese de lesão inflamatória e um tratamento com corticosteróides foi iniciado. Após oito dias de tratamento uma melhora clínica e radiológica significativas foram observadas. O paciente permanece assintomático.

Pseudotumor inflamatório de fígado: relato de caso / Inflammatory pseudotumor of the liver: case report

Pseudotumor inflamatório é lesão benigna rara que pode se desenvolver em uma grande variedade de órgãos. Sua importância na prática médica reside na dificuldade de distingui-lo de condições malignas...

Inflammatory pseudotumor is a rare benign lesion which can occur in a great variety of organs. The diagnosis is difficult to be made because it is similar in appearance to malignant entities...

Pseudossarcoma inflamatório primário de bexiga: relato de caso / Primary inflammatory pseudossarcoma of the bladder: case report

O pseudossarcoma inflamatório primário de bexiga é um tumor raro, com apenas 50 casos na literatura. Clinicamente e pelos exames de imagem, ele é indistinguível de tumores malignos, sendo que apenas a histologia consegue diferenciá-lo, mesmo assim com dificuldade. O tratamento é cirúrgico, havendo recidivas apenas quando ele não é completamente ressecado. Os autores relatam um caso de pseudossarcoma inflamatório de bexiga em paciente feminina de 40 anos, que apresentou recidiva após ressecção inicial e boa evolução após nova intervenção cirúrgica

Seudotumor inflamatorio de higado / Inflammatory pseudotumor of liver

Se estudia el caso de una niña de 6 años de edad, procedente del área rural del municipio de Chinchiná (Caldas), quien consultó por cuadro clínico consistente en ictericia de un mes de evolución, sin otros síntomas asociados. Las pruebas de funcionamiento hepático mostraron un patrón obstructivo de la vía biliar y la ultrasonografía y tomografía axial computarizada abdominal, evidenciaron la presencia de masa en el hilio hepático, con dilatación de las vías biliares. Se tomaron muestras de la lesión tumoral por laparotomía, las cuales fueron reportadas como proceso inflamatorio, hamartoma mesenquimal y seudotumor inflamatorio. La paciente se manejó con un tubo sinfín para drenaje de las vías biliares, que fue factor determinante en la recuperación. Después de revisar las características clínicas, radiológicas y anatomopatológicas, se llegó a la conclusión que se trataba de un seudotumor inflamatorio

Pseudotumor inflamatorio del pulmón en la infancia / Lung inflammatory pseudotumor in childhood

Introducción. El pseudotumor inflamatorio del pulmón es una lesión no neoplásica que puede simular un proceso maligno y que explica más de la mitad de los casos de masas pulmonares en la infancia. Existen escasas publicaciones de esta enfermedad en la edad pediátrica. Casos clínicos. Se describen 2 pacientes con pseudotumor inflamatorio del pulmón tratados quirúrgicamente, haciendo énfasis en los hallazgos clínicos, radiológicos e histopatológicos.Conclusión. Debe sospecharse esta enfermedad ante la presencia de masa intrapulmonar en la radiografía de tórax con antecedente de proceso infeccioso. El diagnóstico es forzosamente histopatológico y el tratamiento siempre es quirúrgico. Lesión intrapulmonar; pseudotumor inflamatorio; granuloma de células plasmáticas.

Inflammatory pseudotumor of urinary bladder

A previously healthy 44-year-old male was admitted with the chief complaint of intermittent gross hematuria. On initial ultrasonographic and CT examination, a grossly protruding intravesical tumor was noted and, under the impression of a malignant bladder tumor, transurethral resection was performed. The histological findings were spindle cells with elongated cytoplasm with rare mitotic figures distributed in myxoid stroma, consistent with diagnosis of inflammatory pseudotumor of the bladder. The benign nature of this tumor warrants conservative surgical management, usually consisting of transurethral resection or partial cystectomy. No reports of metastasis have been reported following complete excision. Therefore, any suspicion and recognition of this entity is imperative to avoid performing an irreversible radical procedure.

Granuloma de células plasmáticas de laringe em uma paciente com 15 anos de idade / Plasma cell granuloma of the larynx in a patient with 15 years old

O granuloma de células plasmáticas (UCP) raramente é encontrado na laringe, podendo simular outras neoplasias, como: plasmocitoma, schwannoma ou tumores malignos. Os autores apresentam um caso de granuloma de células plasmáticas da laringe em paciente do sexo feminino, com 15 anos de idade, que se apresentou com rouquidäo e sensaçäo de peso na garganta. A laringoscopia direta mostrou obstruçäo quase total da luz por abaulamento da parede lateral esquerda da subglote. A paciente foi submetida a ressecçäo cirúrgica extramucosa do tumor, apresentando-se sem evidência de doença após um ano de seguimento e com funçäo fonatória preservada. Raros casos existem na literatura; porém, este é o primeiro caso na faixa pediátrica

Pseudotumor inflamatorio / Inflammatory pseudotumor

We report a 63 years old man presenting with a history of persistent cough and blood streaked aputum. Chest X rays and CAT scans showed a tumoral lesion between the superior and inferior right lobes. The tumor was resected and its pathological examination revealed an inflammatory pseudotumor. It is concluded that this type of tumors must be born in mind in patients with nodular lesions of the lung