Pseudotumor instead of liver cancer
In a 44-year-old man, doctors in Leipzig discovered a tumor on the liver and feared cancer. The tumor suddenly seemed to disappear on images of computer tomography. Tissue removal finally put the doctors on the right track.
Fatigue and night sweats A 44-year-old man reported to the Leipzig university clinic and told the doctors that he was constantly feeling tired, had a fever and night sweats. The complaints had been going on for ten days and, moreover, in the past week there had been an additional pain in the knees after the sport. When asked by internist Thomas Karlas and his colleagues whether the patient had had similar complaints in the past, the patient replied that this had actually been the case in the past and previous year. The complaints then went away on their own. In the specialist magazine "Gastroenterology", the doctors describe the case in which the patient's history was otherwise unremarkable. The man had smoked until ten years ago, does not suffer from chronic diseases and there is no evidence of infectious diseases that he could have brought with him from travel.
Suspected cancer The physicians find that both knees are slightly swollen during the examination, but nothing else is apparent that could explain why the man is suffering from the symptoms. The blood analysis then gives clear indications of inflammation, and some of the liver values are also increased. The patient has too low a concentration in the blood of the red blood pigment, the hemoglobin that is important for oxygen transport. The concentration of platelets and the platelets required for clotting is also slightly increased. There are different causes for both findings and x-rays and an analysis of the urine remain without striking results. Finally, the doctors find what they are looking for with an ultrasound scan. In the liver, they come across a structure that is two by two centimeters in size, which could be a malignant tumor. With the help of a contrast agent, the doctors see how the structure is supplied by a blood vessel. This is the case for most tumors above a certain size, but not for many benign changes. So they see themselves confirmed in their assumption that the patient has cancer.
Images seem to contradict each other After computed tomography examinations, doctors are no longer so sure. The tumor almost disappears on the CT images. Only magnetic resonance imaging (MRI) makes the structure visible again. In positron emission tomography (PET), the doctors recognize that the cells in the suspicious area consume large amounts of blood sugar. This would in turn fit a malignant tumor. The different images seem to contradict each other and do not produce a clear result. The doctors finally decide to perform a biopsy of the liver, in which they take a small piece of tissue.
Diagnosis of pseudotumor When analyzing the tissue, pathologists find no evidence of a malignant tumor, but they notice a large number of densely packed defense cells. The diagnosis is made after a more detailed examination of the cells in the laboratory: the patient has an inflammatory pseudotumor (inflammatory pseudotumor) in the liver. The defense system against such tumors, which are very rare, is directed against the body itself. It is an autoimmune disease that can affect various organs such as the pancreas, lungs or the liver. It can only be correctly diagnosed if the doctors perform a biopsy in good time. For a long time, pseudotumors were only recognized after the operation of the supposedly malignant tumors.
Pseudotumors rarely need to be surgically removed. The patient in Leipzig received prednisolone, a relative of the body's hormone cortisol, after diagnosis. The drug suppresses inflammatory reactions and the complaints of the 44-year-old quickly resolved. His inflammatory levels in the blood also normalized. However, the man relapses when doctors try to treat him with a small amount of cortisone-related medication. Finally, with the help of a combination of different substances that suppress the immune system, it is possible to permanently suppress its symptoms. The pseudotumor can still be seen in ultrasound examinations, but the inflammation seems to have lost activity. The tumors shrink in some patients even without treatment. However, the majority of those affected need therapy with steroids, the relatives of cortisol. Only in cases where this does not help do pseudotumors have to be surgically removed. (ad)
Image: Martin Büdenbender / pixelio.de