A case of inflammatory pseudotumour of the gallbladder presenting as a big mass of uncertain behavior
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CASE REPORT
Open Access
A case of inflammatory pseudotumour of the gallbladder presenting as a big mass of uncertain behavior Antonio Calvo* , Jesús Salas, Gloria Muñoz, Ana Díez and María Coral de la Vega
Abstract Background: Inflammatory pseudotumour has been used to describe an inflammatory or fibrosing tumoral process of an undetermined cause that may involve a variety of organ systems, including the lungs, spleen, liver, lymph nodes, pancreas and extrahepatic bile duct with potential for recurrence and persistent local growth. In this article, we report a patient with a big mass of uncertain nature and behavior. Case presentation: A 60-year-old woman presented with a 1-week history of abdominal pain, fever and jaundice. Six months before she had had right upper quadrant pain that was interpreted as biliary colic. A contrast-enhanced CT scan showed a big mass of soft tissue with diffuse infiltration of the gallbladder, displacement of the transverse colon, hepatic flexure and duodenum. For diagnostic distinction between a chronic inflammatory disease or a neoplasm, exploratory laparotomy was required. Intraoperative exploration disclosed a big mass of hard texture involving the gallbladder, with multiple concrements, hepatoduodenal ligament, right and transverse mesocolon, stomach and duodenum. Cholecystectomy was performed, preserving adjacent organs with macroscopic desmoplastic reaction. Histopathologic examination of the gallbladder showed a spindle cell proliferation with diffuse chronic inflammatory infiltrate of lymphocytes, plasma cells and hyalinized fibrous stroma. No vascular invasion or cellular atypia were evident. Conclusion: Inflammatory pseudotumour is a rare condition and diagnostic distinction from a chronic inflammatory disease or other neoplasm is only possible by histopathologic examination. There is a limited number of case reports in the literature indicating tumor location in the gallbladder. Keywords: Inflammatory Pseudotumor, Gallbladder
Background Inflammatory pseudotumour is a rare lesion that has been described in various organs and tissues. Intraabdominal variants of the disease are reported to occur most frequently in the liver, spleen, mesentery, and extrahepatic bile duct. The location of the gallbladder is even more uncommon. * Correspondence: [email protected] Department of Surgery and Pathology, Puerto Real University Hospital, Cádiz, Spain
Malignant transformations and recurrences of inflammatory pseudotumour have been reported years after surgery, therefore long-term follow-up is necessary even for patients successfully treated by surgical resection. Elevated IgG4 serum levels have been reported in association with this illness as well as abundant IgG4 positivity in tumor infiltrating plasma cells, signs suggestive of an IgG4-related disease. A high serum IgG4 concentrations, thus provides a useful means of distinguishing this disorder from other differential diagnoses.
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0
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