Hepatic inflammatory pseudotumors with portal vein thrombosis and extremely elevated α-fetoprotein level

Hepatic inflammatory pseudotumors (HIPTs) are rare non-neoplastic lesions. Because HIPTs often mimic hepatocellular carcinoma on ultrasonography and computerized tomography scan, they are difficult to distinguish from malignant lesions preoperatively even with advanced image studies. According to the literature, elevated α-fetoprotein might be the only possible non-invasive test to differentiate hepatic inflammatory pseudotumors from hepatocellular carcinoma. A 61-year-old male hepatitis C virus carrier presented with a hepatic tumor and elevated α-fetoprotein levels (α-fetoprotein = 11,241 μg /L). Abdominal computerized tomography and ultrasonograhy revealed typical signs of right hepatic lobe hepatocellular carcinoma with right intrahepatic portal vein invasion and tumor thrombi formation. He underwent trisegmentectomy (Seg. 5, 6, 7 according to Couinaud's classification) and portal vein thrombectomy. The pathological diagnosis was HIPT. Postoperative α-fetoprotein level lowered immediately and long-term follow-up with ultrasonography has revealed no evidence of tumor regrowth for the past two years. Elevated α-fetoprotein is a specific tool for detecting the occurrence of hepatocellular carcinoma in patients with underlying chronic viral hepatitis. However, our patient had extremely elevated α-fetoprotein, but pathology revealed HIPT. This suggests that the differentiation between inflammatory pseudotumors and hepatocellular carcinoma requires biopsy. Surgical intervention still plays a role in long-term follow-up for chronic viral hepatitis carriers who also have hepatic inflammatory pseudotumors.