PMC9256424_01
(a) Magnetic resonance imaging (MRI) of the abdomen demonstrating hepatic IPT prior to treatment with steroid taper. (b) MRI of the abdomen after treatment showing complete resolution of hepatic IPT. (c) Endoscopic ultrasound demonstrating a periportal mass.
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The CT scan showed a mass-like mural thickening at the hepatic hilum concerning for a Klatskin tumor (Figure 1). EUS confirmed an irregular hypoechoic mass in the porta hepatis measuring 4.1 x 2.7 cm (Figure 1).
(a-d) Hepatocellular parenchyma with a mixed predominately mononuclear inflammatory infiltrate and reactive fibrosis, with residual bile duct elements present. (c) 400x total magnification; infiltrate is mainly comprised of lymphocytes and plasma cells. (d) The interface of the inflammatory process with background liver tissue. (e) Arrows highlight the residual elastic lamina.
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A subsequent CT-guided biopsy of the hilar mass also confirmed IgG4-positive plasma cells and obliterative phlebitis, consistent with IgG4 -associated hepatic IPT (Figure 2).