Inflammatory Myofibroblastic Tumor of the Liver: Challenges in the Preoperative Diagnosis and Treatment

Excerpt

A 48-year-old Chinese woman was presented to our department with a hepatic mass on routine physical examination. She was almost asymptomatic. She denied previous radiotherapy or industrial chemical exposure. Physical examination was unremarkable. Liver function was within reference range. Serological testing for tumor markers, hepatitis B, and C were also negative. Magnetic resonance imaging (MRI) of the upper abdomen showed a 3.2 × 3.5 cm, appearing hypo-intense relative to the liver on T1-weighted images (Fig. 1a) and hyper-intense on T2-weighted images (Fig. 1b). Due to the similar appearance, hepatocellular adenoma, intrahepatic cholangiocarcinoma, or hepatic alveolar echinococcosis was considered for preoperative diagnosis. The patient eventually underwent a liver resection of segment VII. Microscopically, the hepatic lesion exhibited a mixture of chronic inflammatory cells and spindle cells (Fig. 2a). Immunohistochemical analysis showed tumor cells positive for smooth muscle actin (Fig. 2b), anaplastic lymphoma kinase-1 (Fig. 2c), and negative for CD34, CD99, EMA, PCK, supporting the diagnosis of inflammatory myofibroblastic tumor of the liver (IMTL). Postoperative recovery of the patient was well.

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