The Disappearance of Lymph Node Metastasis from Neuroendocrine Carcinoma after Endoscopic Ultrasound-guided Fine Needle Aspiration.

A 75-year-old Japanese man was referred to our hospital to undergo the examination of an enlarged peripancreatic lymph node. Computed tomography (CT) showed a lymph node 47 mm in size that was located above the pancreas head and beneath the liver. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the enlarged lymph node was performed, and an immunohistological examination of the sample confirmed a histological diagnosis of neuroendocrine carcinoma (NEC). The patient refused treatment with chemotherapy and instead chose to undergo observation. However, the lymph node the previously enlarged lymph node was not visible on CT at 12 months after the examination.

A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment.

BACKGROUND: Hepatic inflammatory pseudotumor (IPT) is a rare disease which often mimics a malignant tumor and is therefore often misdiagnosed and surgically resected. Recently, a concept of IgG4-related diseases (IgG4-RD) has been proposed that is becoming widely recognized and includes IgG4-related hepatic IPT. Corticosteroids are widely accepted as the standard treatment. CASE PRESENTATION: A 72-year-old Japanese man, who had been followed for ten years after surgery and chemotherapy for treatment of hilar and lower bile duct cancers, developed intermittent fever and abdominal pain and visited this hospital. Blood examinations revealed an inflammatory reaction, worsened glucose intolerance, and an increased level of serum IgG4 (137 mg/dL). Computed tomography (CT) revealed a 5 cm-sized mass in hepatic segment 7. Because of his cancer history, not only was a benign mass suspected, but there was also the possibility of a recurrent biliary malignancy. Liver biopsy was performed and the histology met the criteria for IgG4-related IPT. Corticosteroid therapy was initiated and his symptoms quickly resolved. However, two months later, a repeat CT demonstrated that the hepatic mass had been replaced by an abscess. The abscess was initially refractory, despite tapering corticosteroid treatment, controlling diabetes by intensive insulin therapy, administration of antibiotics, and percutaneous abscess drainage. Finally, after six months, the condition resolved. CONCLUSION: The diagnosis of hepatic IPT is sometimes difficult. To differentiate it from a malignant tumor, histological examination is necessary. Although corticosteroids are recognized as the standard therapy, unexpected and critical complications can develop in cases of IgG4-related hepatic IPT.