Multifocal Inflammatory Pseudotumors in a Patient with Cirrhotic Liver and Very High Alpha-Fetoprotein: Report of a Case

Hepatic inflammatory pseudotumor (IPT) is a rare benign lesion that is not easy to be differentiated from hepatocellular carcinoma (HCC) without liver biopsy. In Taiwan, HCC is one of the most common cancers, and up to 80% of cases are related to liver cirrhosis; besides, most cases of HCC in Taiwan have chronic hepatitis B or C. We describe a 55-year-old man with chronic hepatitis C and liver cirrhosis who was diagnosed as having hepatic and probable pulmonary IPTs concomitantly. The imaging appearances were clinically indistinguishable from HCC with lung metastasis. The extremely high alpha-fetoprotein level (305, 620ng/mL) in this cirrhotic patient suggested the hepatic lesions were HCC but this was not the case. The hepatic tumors regressed and the pulmonary nodules vanished subsequently without specific treatment except the use of corticosteroid and antibiotics during hospitalization. Alpha-fetoprotein level decreased with the size of these multiple hepatic IPTs in regression. Percutaneous coaxial multiple liver biopsies from the regressing hepatic tumors confirmed the diagnosis of hepatic IPTs. Special attention should be paid to this unusual condition, particularly in regions where HCC is prevalent.