J Korean Surg Soc.  2013 Aug;85(2):89-92. 10.4174/jkss.2013.85.2.89.

Inflammatory myofibroblastic tumor mimicking hepatocellular carcinoma with dense lipiodol uptake

• Hong SW
• Lee WY
• Chang YG
• Lee B
• Lee HK
• Kim HK

• KMID: 2212523
• DOI: http://doi.org/10.4174/jkss.2013.85.2.89

Abstract

Inflammatory myofibroblastic tumor (IMT) of the liver is a very rare lesion that has radiologic similarity with malignant liver tumor. Differential diagnosis of IMT from a malignant lesion of the liver is very important because surgical resection is not mandatory for IMT. Lipiodol computed tomography is a very sensitive and specific diagnostic tool for hepatocellular carcinomas (HCC). Herein, we describe a case of IMT that had dense lipiodol uptake in the tumor and mimicked HCC. To our knowledge, previously, only one case of IMT with dense lipiodol retention has been reported.

Keyword

Inflammatory myofibroblastic tumor; Lipiodol CT; Liver

MeSH Terms

Carcinoma, Hepatocellular
Diagnosis, Differential
Ethiodized Oil
Liver
Myofibroblasts
Retention (Psychology)
Ethiodized Oil

Figure

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  Fig. 1 Abdomen computed tomography prior transhepatic arterial chemoembolization showed gross 5 cm spherical tumor in Segment VII (Couinaud's segment) and Segment VI of liver. Tumor showed slight low attenuation on precontrast scan (A), general high enhancement with central stellate slight low attenuation on arterial phase (B) and remarkable low attenuation with irregular septa-like and peripheral thick rim-like high enhancement on portal phase (C). Hepatic artery angiogram showed spherical tumor stain with no remarkable hypervascularity (D).

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  Fig. 2 Lipiodol computed tomography revealed 4.3 cm densely lipiodol uptaken spherical mass in Segment VII and Segment VI of liver.

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  Fig. 3 Grossly, tumor was 5.2 cm×4.5 cm×4.2 cm in size. It was spherical, well-defined and had smooth contour without capsule. Color of tumor was grayish white to yellow tan.

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  Fig. 4 High power view demonstrates interlacing bundles of myofibroblasts and fibroblasts in a collagenous stroma, with admixture of polymorphic inflammatory cells, including plasma cells, lymphocytes and eosinophils (H&E, ×200).

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