A CASE OF AN INFLAMMATORY PSEUDOTUMOR OF LIVER WITH AN ELEVATED SERUM LEVEL OF CA19-9

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A 51-year-old man was found to have dilatation of the lateral segment of bile duct and a tumor in the vicinity of the umblical portion of the portal vein which seemingly continued with the dilatation on abdominal ultrasonography and CT during exploration for impaired hepatic function. At the same time, a high serum level of CA19-9, more than 500U/ml, was noted. MRCP disclosed dilatation of the lateral segment of bile duct and obstruction at its downstream side. We diagnosed the case as intrahepatic bile duct carcinoma and performed excision of the left lobe as well as left caudate lobe of liver, excision of extrahepatic bile duct, and cholangiojejunostomy. On the section of removed material, a demarcated yellowish-white solid tumor which was adjacent to the left intrahepatic bile duct was identified. Histopathologically proliferation of fibrous connective tissue with invasion of lymphocytes and plas-macytes was seen, and hence the lesion was definitely diagnosed as inflammatory pseudotumor of liver. We had great difficulties in differentiation of the disease from intrahepatic bile duct carcinoma in this case, because imaging studies revealed a tumor with dilatation of the intrahepatic bile duct as well as an elevated level of a tumor maker.
日本臨床外科学会の論文