Doctors find pseudotumor instead of liver cancer

Pseudotumor instead of liver cancer

09/15/2013

In a 44-year-old man Leipzig doctors have discovered a tumor on the liver and feared a cancer. On images of computed tomography, the tumor suddenly disappeared. Tissue removal finally put the doctors on the right track.

Fatigue and night sweats
A 44-year-old man volunteered at the Leipzig University Hospital and told the doctors that he was feeling tired all the time, having fever and nocturnal sweats. The complaints had already been going on for ten days and, in addition, it had been added last week that the knee joints hurt after sports. Asked by the internist Thomas Karlas and his colleagues, if the patient has had similar complaints in the past, he replies that this was indeed the case last year and the previous year. The complaints passed by then. In the trade magazine „Gastroenterology“ Doctors describe the case where the patient's history was otherwise unremarkable. The man had smoked until ten years ago, does not suffer from chronic illness, and there is no evidence of infectious diseases he may have brought with him from traveling.

Suspected cancer
While the doctors determine during the investigation that both knees are slightly swollen, otherwise nothing is noticeable, which could explain why the man suffers from the symptoms. Clear evidence of inflammation then results in the blood analysis, also a part of the liver values ​​is increased. The patient has too low a concentration in the blood of the red blood pigment, the hemoglobin important for the transport of oxygen. The concentration of platelets, platelets needed for coagulation is also slightly increased. There are different causes for both findings and also X-rays and an analysis of the urine remain without any noticeable results. Finally, the doctors will find an ultrasound examination. In the liver, they encounter a two-by-two-centimeter structure, which could be a malignant tumor. The doctors see with the help of a contrast agent, how the structure is supplied by a blood vessel. For most tumors, this is the case from a certain size, but not in many benign changes. So they see themselves confirmed in their assumption that the patient is suffering from cancer.

Pictures seem to contradict each other
After computed tomography examinations, however, the doctors are no longer so sure. The tumor almost disappears on the CT images. Only a magnetic resonance tomography (MRI) makes the structure visible again. The physicians recognize in a positron emission tomography (PET) that the cells at the suspect site consume large amounts of blood sugar. This in turn would be consistent with a malignant tumor. The different pictures seem to contradict and do not bring a clear result. The doctors finally decide on a biopsy of the liver, in which they remove a small piece of tissue.

Diagnosis pseudotumor
In the analysis of the tissue, the pathologists find no evidence of a malignant tumor, but they are a variety of tightly packed defense cells. The diagnosis is made after a closer examination of the cells in the laboratory: The patient suffers from an inflammatory pseudotumor (inflammatory pseudotumor) in the liver. The defense system is aimed at the tumors, which are very rare, against the body itself. So it is an autoimmune disease that could affect various organs such as the pancreas, lungs or just the liver. It can only be diagnosed correctly if the doctors perform a biopsy in good time. For a long time, pseudotumors were recognized only after the operation of supposedly malignant tumors.

Pseudotumors rarely need to be surgically removed
The patient in Leipzig was diagnosed with prednisolone, a relative of the endogenous hormone cortisol. The drug suppresses inflammatory reactions and the 44-year-old's complaints quickly disappeared. Likewise, his inflammatory levels in the blood normalized. However, the man relapses as doctors try to treat him with a small amount of cortisone-related medication. Finally, it succeeds with the help of a combination of various immune system suppressing agents to suppress its symptoms permanently. Although the pseudotumor can still be seen in ultrasound examinations, the inflammation seems to have lost its activity. The tumors shrink in some patients without treatment. However, the majority of sufferers need steroids therapy, the cortisol relatives. Only in cases where this does not help do pseudotumors have to be removed surgically. (Ad)