Vanishing-recurrent benign liver lesions

Inflammatory pseudotumour of the liver is a rare benign condition which may mimic malignant tumours. It is associated with many diseases including Crohn's disease, diabetes and Sjögren's syndrome [1]. Inflammatory pseudotumour of the liver presents a variable appearance on Magnetic Resonance Imaging (MRI), and spontaneous regression at follow-up has been reported [2, 3]. A 37-year-old woman with a history of primary antiphospholipid antibody syndrome with first trimester miscarriage and recurrent pulmonary embolism treated with warfarin, underwent an abdominal ultrasound (US) which revealed on the right liver multiple oval hypoechoic lesions (mean diameter 10–20 mm); after sulphur hexafluoride injection, lesions displayed centripetal arterial enhancement and early wash out. She denied symptoms. Liver function tests were normal, as well as tests for HBsAg, anti-HCV and autoimmune diseases. Erythrocyte sedimentation rate was 73 mm/h and Protein C reactive was 39 mg/L. An MRI showed (Fig. 1) multiple T2-hyperintense lesions that have restricted diffusion on Diffusion-Weighted Imaging. The vascular study demonstrated a peripheral arterial enhancement with delayed central uptake, while the hepatospecific phase showed no enhancement. Liver biopsy showed fibrovascular tissue embedding biliary ducts and infiltrated by lymphocytes, plasma cells and granulocytes. During a quarterly follow-up, MRI revealed that some lesions spontaneously were reduced or even disappeared but other enlarged or appeared. A final diagnosis of an inflammatory pseudotumour of the liver was made. At present, patient continues to be asymptomatic. Here, we report the first case of association of hepatic inflammatory pseudotumour and antiphospholipid syndrome, with a peculiar vanishing-recurrent pattern of liver lesions.