Inflammatory myofibroblastic tumor mimicking hepatocellular carcinoma with dense lipiodol uptake
A 60-year-old woman was admitted at our hospital for evaluation and management of liver tumor. Two months ago, she felt general weakness. She had weight loss, 5 kg/2 wk. She visited a local hospital due to the above problems. She was checked by abdominal sono whereby a liver tumor was identified. Laboratory results at that time were not available. The impression was HCC at that time. Thus, she was treated with transhepatic arterial chemoembolization (TACE) by using adriamycin (50 mg), lipiodol and gelfoam. Two weeks after TACE, she visited our hospital for operation. She felt general weakness and had no other symptoms. She had diabetes mellitus that was treated with oral hypoglycemic agents. She had no history of hepatitis B or C. Blood pressure was 120/70 mmHg. Pulse rate was 76/min. Temperature was 36.0℃. She was not icteric. Neither abdominal mass nor liver were palpable.\nAbnormal laboratory results were decreased hemoglobin, 10.0 g/dL (reference range, 12.0 to 16.0 g/dL); elevated erythrocyte sedimentation rate, 122 mm/hr (reference range, 0 to 22 mm/hr); and elevated gamma-glutamic transpeptidase, 81 IU/L (reference range, 7 to 32 IU/L). Hepatitis B surface antigen was negative and surface antibody was positive. Hepatitis C antibody was negative. Tumor markers were all nor mal; alpha-fetoprotein, 3.2 ng/mL (reference range, 0 to 10 ng/mL); carcinoembryonic antigen, 0.4 ng/mL (reference range, 0 to 5 ng/mL); carbohydrate antigen 19-9, 10.2 U/mL (reference range, 0 to 37 U/mL).\nAbdomen CT checked prior to TACE showed a gross 5 cm spherical tumor in Segment VII (Couinaud's segment) and Segment VI of the liver. The tumor showed slight low attenuation on precontrast scan (). On arterial phase, this tumor showed general high attenuation with central stellate slight low attenuation (). On portal phase, a major portion of the tumor showed remarkable low attenuation with irregular septa-like and peripheral thick rim-like high enhancement (). Hepatic artery angiogram showed spherical tumor stain with no remarkable hypervascularity (). Lipiodol CT, which was taken 14 days following TACE, revealed a 4.3 cm densely lipiodol uptaken spherical mass in segment S6 and S7 of the liver (). Right post sectionectomy was done with the diagnosis of HCC.\nIn the specimen, the tumor was 5.2 cm×4.5 cm×4.2 cm in size. It was spherical, well-defined and had smooth contour without capsule. The color of tumor was grayish white to yellow tan (). High power view demonstrates interlacing bundles of myofibroblasts and fibroblasts in a collagenous stroma, with an admixture of polymorphic inflammatory cells, including plasma cells, lymphocytes and eosinophils (). Immunohistochemical stain revealed positive activity of vimentin (diffuse +), smooth muscle actin (mainly +) and desmin (focal +). The final diagnosis was IMT.\nThe patient recovered well without any complication. Regular follow-up studies including abdomen CT showed no recurrence of tumor for 5 years after operation.