肝脏炎性假瘤

　　至今肝脏炎性假瘤确切的病因仍不清楚，可能与创伤、感染及免疫变态反应等因素有关。

　　1、感染学说

　　临床上IPT可有发热、白细胞升高、血沉加快、血浆C反应蛋白增加等炎性反应的表现。有报道复发性胆管炎伴有IPT，可推测胆管上行性感染所致的化脓性炎症过程与上述表现有关。Horiuchi收集文献20例肝脏IPT中，有7例伴发闭塞性静脉炎，即炎性假瘤的门静脉属支发生由多量组织细胞形成的肉芽肿性静脉炎，致管壁增厚，管腔狭窄，从而认为微生物可源自食物或炎性病灶，经血流到达门静脉，其后在肝实质内逐渐发展成上述闭塞性静脉炎及肉芽肿性炎症。此外，不少学者认为肉芽肿型肝脓肿的坏死组织周围有组织细胞、巨细胞及胶原纤维化，酷似炎性假瘤，应属炎性假瘤的范围。

　　2. Immune response theory

　　IPT shows a large number of plasma cells histologically, suggesting a possible endogenous or exogenous factor-induced immune pathological reaction. Many scholars believe that the changes in occlusive phlebitis mentioned above are similar in nature to those in Riedel's thyroiditis, idiopathic retroperitoneal fibrosis, and mediastinal fibrosis, and are considered an autoimmune disease. In Chinese cases, there are also multiple cases of occlusive phlebitis, and these vascular changes may be related to immunity or infection, or both.

　　Individual patients with inflammatory pseudotumor of the liver may develop portal hypertension. Although there is a 2.7% risk of malignancy in pulmonary inflammatory pseudotumor, there have been no reports of malignancy in liver inflammatory pseudotumor. However, patients should still be vigilant and seek timely treatment upon discovery of the disease.

　　Literature reports that inflammatory pseudotumor of the liver is more common in children, with most patients having a single lesion, and some having multiple lesions. The main clinical manifestations of most patients include upper abdominal pain, intermittent fever with weight loss, and some patients have symptoms such as fatigue, discomfort, nausea, and vomiting. About 10% of patients have jaundice. During physical examination, some patients can palpate a tough, smooth mass, and generally without signs of liver cirrhosis such as palmar erythema and spider nevi.

　　There is no regularity in the age of onset and gender of this disease, nor are there clear clinical symptoms. It is often discovered incidentally by ultrasound. The final diagnosis of inflammatory pseudotumor still requires pathological diagnosis, and the diagnosis before surgery can be made clear by fine needle aspiration biopsy guided by ultrasound.

　　Inflammatory pseudotumor of the liver develops slowly with mild symptoms and has a certain degree of infectivity. It is necessary to be vigilant and achieve early detection and early treatment. We should actively treat, take appropriate rest, and supplement nutrition, which may also help recover health in a short period of time. For the problem of the mass, one must be cheerful, and it is appropriate to use traditional Chinese medicine for prevention. Methods such as soothing the liver, invigorating the spleen, promoting blood circulation, softening hardness, and dispersing nodules can be used for conditioning, and drugs such as salvia miltiorrhiza, poria, and cyperus rotundus can be used for preventive treatment.

　　Inflammatory pseudotumor of the liver has no clear clinical symptoms and is often discovered incidentally during B-ultrasound examination. The final diagnosis of inflammatory pseudotumor still requires pathological diagnosis, and fine needle aspiration biopsy guided by ultrasound before surgery can make an accurate diagnosis.

　　1. Some patients may have anemia, mild to moderate elevation of total white blood cell count, accelerated erythrocyte sedimentation rate, and increased plasma C-reactive protein. A few may have elevated ALP, ALT, γ-GT, and LDH, negative HBsAg, and normal AFP.

　　2. Ultrasound examination shows that liver tumors are round or oval masses with clear boundaries, and Doppler shows less blood flow. If the mass is located on the liver surface and has inflammatory adhesions with the abdominal wall, it is often found in the ultrasound image.

　　3. CT scan shows no liver sclerosis, the spleen does not swell, and the lesion site appears as a low-density shadow with clear boundaries. Small inflammatory pseudotumors are difficult to distinguish from liver cancer. However, it is easier to distinguish from hemangiomas after contrast agent injection.

　　4. MRI shows that the liver surface of inflammatory pseudotumors is smooth, the portal vein does not dilate, the spleen does not swell, the tumor appears as low signal on T1-weighted imaging, and there is no compression, narrowing, or displacement of blood vessels near the focus. It appears as high signal and has clear boundaries on T2-weighted imaging. Selective liver angiography is of great significance for those who cannot be diagnosed by the above tests. Inflammatory pseudotumors show no blood supply or no vascular hyperplasia, which can be distinguished from liver cancer.

　　Patients with liver inflammatory pseudotumors should increase their intake of various vitamins in their daily life, such as vitamin A, B1, B6, B12, C, and D. They should eat fresh vegetables, fruits, and foods rich in fiber, eat nuts regularly, and pay attention to nutritional supplementation. It is advisable to avoid eating cold, spicy, and irritating foods, avoiding high-fat foods such as fatty meat and animal fat, avoiding smoking and drinking. In addition, they should maintain an optimistic attitude, avoid staying up late, and engage in moderate physical exercise.

　　At present, the vast majority of inflammatory pseudotumors are surgically treated due to misdiagnosis or inability to exclude liver cancer, so surgical treatment is the main treatment method for liver inflammatory pseudotumors. The purpose of surgical treatment is to make an accurate diagnosis and remove the focus. However, there is currently no consensus on the surgical method, with diverse reports, but in principle, it should be determined according to the location and extent of the focus. Generally, inflammatory pseudotumors in clinical practice are mostly solitary and have clear boundaries, the focus is superficial and easy to see, mostly located on the diaphragmatic surface of the liver, so the surgical difficulty will not be too great, and therefore, China currently advocates for resection. For inflammatory pseudotumors that cannot be resected, biopsy should be performed to make an accurate diagnosis. Inflammatory pseudotumors with jaundice often have the focus located within the porta hepatis, which is difficult to resect, and can undergo bile duct drainage or bypass surgery, and in some cases, liver transplantation may be necessary.