Inflammatory pseudotumor of the liver
Introduction
Introduction to hepatic inflammatory pseudotumor Hepatic inflammatory pseudotumor is a benign proliferative lesion characterized by inflammatory hyperplasia of the liver and non-hepatic parenchymal cell components. The etiology and mechanism of this disease are unknown and rare. Pack 1953 Since the first report of the year, there have been 53 reports from Schmid et al in 1996. However, since the 1980s, the report of this disease has gradually increased. The country was first reported by Feng Yuquan in 1991, and nearly 50 cases have been reported. . With regard to the current level of imaging diagnosis, IPT is still difficult to distinguish from liver malignant tumors, and almost all surgical resections of the tumor are performed. Therefore, it is necessary to study and improve the diagnostic level of IPT. basic knowledge The proportion of illness: 0.01%-0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: portal hypertension
Cause
Causes of hepatic inflammatory pseudotumor
(1) Causes of the disease
The exact cause of hepatic inflammatory pseudotumor remains unclear, and may be related to factors such as trauma, infection and immune allergic reaction.
Infection factor (32%):
Clinically, IPT may have fever, elevated white blood cells, accelerated erythrocyte sedimentation rate, increased plasma C-reactive protein and other inflammatory reactions. It has been reported that recurrent cholangitis with IPT can be used to speculate on the suppurative inflammatory process caused by ascending bile duct infection. Related to the above performance, Horiuchi collected 20 cases of liver IPT, 7 cases of occlusive phlebitis, that is, the portal vein branch of inflammatory pseudotumor developed granulomatous phlebitis formed by a large number of tissue cells, resulting in thickening of the wall The lumen is narrow, so that the microorganism can be derived from food or inflammatory lesions, and the blood flow reaches the portal vein, and then gradually develops into the above-mentioned occlusive phlebitis and granulomatous inflammation in the liver parenchyma. In addition, many scholars believe that the granulation is There are tissue cells around the necrotic tissue of swollen liver abscess, giant cells and collagen fibrosis, which resembles inflammatory pseudotumor, and should be in the range of inflammatory pseudotumor.
Immune response (30%):
There are a large number of plasma cells in the histology of IPT, so that it may consider an immunopathological reaction caused by endogenous or exogenous factors. Many scholars believe that the above-mentioned changes in occlusive phlebitis and Riedel thyroiditis, idiopathic peritoneum The characteristics of vascular changes such as posterior fibrosis and mediastinal fibrosis are the same, and it is an autoimmune disease. In domestic cases, there are also many cases of occlusive phlebitis, which may be related to immunity or infection, or Both have both.
(two) pathogenesis
The basic pathological features of IPT are inflammatory hyperplasia, a focal lesion composed of various chronic inflammatory cell infiltration mainly composed of fibrous matrix and plasma cells, mostly round or elliptical, with a diameter of 1 to 25 cm. The largest report is 25cm × 25cm × 13cm. In recent years, it is easy to be discovered due to the widespread application of imaging techniques such as B-ultrasound. Most of them are small lesions with a diameter of 2 to 4 cm. IPT is more common on the surface of the liver, and can be associated with the abdominal wall, diaphragm and surrounding tissues. Inflammatory adhesions; a few can be located in the deep or first part of the liver parenchyma, near the liver gate, the liver inflammatory pseudotumor has a complete envelope, clear boundaries, hard, tough, its cut surface is smooth and flat, grayish white or yellow, visible under the microscope Plasma cells, tissue cells, fibroblasts and ring cells, and other inflammatory cells, there are obvious inflammation and fibrous tissue proliferation around the lesions, and some may be a large number of hepatocyte necrosis, but liquefaction is rare, the liver usually has no cirrhosis.
The cellular components of inflammatory pseudotumors vary from case to case, and Someren divides IPT into three tissue types based on its cellular components:
1 is a sclerosing pseudotumor mainly characterized by diffuse and dense fibrous hyperplasia;
2 The tissue granuloma is called yellow granuloma;
3 Plasma cells are mainly called plasma cell granuloma. It is not clear how these tissue types are closely related to clinical processes.
Prevention
Hepatic inflammatory pseudotumor prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease. Don't be too nervous in spirit, keep your spirits happy, and don't smoke or drink. Pay attention to rest, reasonable diet: patients should not be overworked. You can walk, play Tai Chi, and do some proper sports. Ensuring adequate sleep and promoting high protein intake, low fat, proper calories and a diet rich in vitamins and various trace elements.
Complication
Hepatic inflammatory pseudotumor complications Complications portal hypertension
Individual IPT patients can be complicated by portal hypertension. Although there are 2.7% cancerous inflammatory pseudotumor in the lungs, liver inflammatory pseudotumor has not been reported to have cancer.
Symptom
Hepatic inflammatory pseudotumor symptoms Common symptoms Weight loss Upper abdominal pain Spider nausea Heart palm fatigue Yellow jaundice
The literature reports that the incidence of the disease is more common in children, patients are mostly single lesions, some are multiple, most patients with clinical manifestations of upper abdominal pain, intermittent fever with weight loss, some patients have fatigue, discomfort, nausea, vomiting and other symptoms About 10% of patients have jaundice. Some patients can touch the tough and smooth mass during physical examination. Generally, there are signs of liver cirrhosis such as liver palm and spider mites.
There is no regularity in the age and gender of the disease, and there is no clear clinical symptoms. Most of them are accidentally discovered by ultrasound. The final diagnosis of inflammatory pseudotumor still requires pathological diagnosis. Preoperative diagnosis can be performed by ultrasound-guided fine needle aspiration biopsy. Clarify its diagnosis.
Examine
Examination of hepatic inflammatory pseudotumor
Most of them are normal, some patients may have anemia, white blood cells are mild or moderately elevated, erythrocyte sedimentation rate is accelerated, plasma C-reactive protein is increased, and a few may also have ALP, ALT, -GT, LDH, etc., HBsAg negative, AFP As normal, there have been reports of a small increase in AFP in a few cases at home and abroad. In China, 2 cases of 25 cases have elevated AFP, and surgical resection confirmed inflammatory pseudotumor; 1 case reported AFP up to 1080g/L, postoperative pathology report For the liver inflammatory pseudotumor with hepatocyte proliferation, the mechanism, regularity and clinical significance of AFP elevation in individual patients remains to be further studied.
Ultrasound examination showed that the liver was normal, the tumor was a round or elliptical mass, the small one was only 2cm, the boundary was clear, and the Doppler was less blood. If the tumor is located on the surface of the liver and has an inflammatory adhesion to the abdominal wall, it can often be found on the sonogram. CT Scanning the liver without sclerosis, the spleen is not swollen, the lesions are low-density shadows, the boundary is clear, and small inflammatory pseudotumors are difficult to distinguish from liver cancer, but it is easier to differentiate from hemangioma after injection of contrast agent. MRI has been applied in recent years. In liver diagnosis, the liver surface of the inflammatory pseudotumor of the liver is smooth, the portal vein is not dilated, the spleen is not swollen, and the tumor shows a low signal on the T1-weighted image. The blood vessels near the lesion are not compressed, narrowed, displaced, and T2-weighted. It is characterized by high signal and clear boundary. Selective liver angiography is of great significance for those who cannot be diagnosed by the above examination. The inflammatory pseudotumor shows no blood supply or no angiogenesis, which can be differentiated from liver cancer.
Diagnosis
Diagnosis and diagnosis of hepatic inflammatory pseudotumor
Differential diagnosis
In addition to differentiation from hepatic hemangioma, hepatic adenoma and focal hyperplasia, inflammatory pseudotumor should be differentiated from hepatocellular carcinoma. The following points are helpful for the diagnosis of hepatic inflammatory pseudotumor:
1 The course of disease is longer, the symptoms are milder, the body condition is better, or there is a liver occupying lesion with unexplained fever;
2 no history of hepatitis, HBsAg negative, no cirrhosis, normal liver function;
3AFP negative;
4B ultrasound, CT and other imaging examinations are liver lesions, but angiography helps to distinguish;
5B ultra- or CT-guided biopsy is a variety of chronic inflammatory cells, but no tumor cells.
