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Phlebitis
Report of a Case in a Child and Review of the Literature
Someren, Ayten: "Inflammatory pseudotumor" of liver with Departments of Pathology, Emory University School of
occlusive phlebitis. Report of a case in a child and review of the Medicine and Grady Memorial Hospital, Atlanta, Georgia
literature. Am J Clin Pathol 69: 176-181, 1978. An unusual
"tumor" involving the right lobe of the liver of a young child is
reported. Morphologically, the lesion had the features of
"inflammatory pseudotumor." We were able to find only one served identical changes in an inflammatory pseudo-
previous report of a similar case in the literature. Unusual tumor of the parotid gland. 33
changes, which may be designated "occlusive phlebitis," were
present in the medium-sized and large veins. Histologically, the
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Vol. 69 • No. 2 CASE REPORTS 177
Pathology
Gross
The specimen consisted of the right lobe of the liver,
which weighed 440 g and measured 15 x 12 x 7 cm. On
sectioning, an 8 x 6 x 6 cm mass was seen, immediately
under the capsule, on the free edge of the liver. The cut
surfaces of the lesion were yellowish-white and firm. It
appeared fairly well circumscribed but not encapsulated
(Fig. 1). The excision margin of the liver was 8 mm from
the main tumor mass. Surrounding liver tissue
appeared grossly normal. The gallbladder showed no
gross abnormality.
Microscopic
Multiple sections of the lesion were examined. In Fio. 1. Parallel sections through the resected right lobe of the liver,
showing a fairly well circumscribed mass.
addition to routine hematoxylin and eosin stains,
Masson's trichrome, Verhoeff's elastica, Gram, peri-
Discussion
Lesions classified as "inflammatory pseudotumor,"
"post-inflammatory tumor," or "plasma cell gran-
uloma" have been found in a variety of locations: The
lung,1'4-6'14'19-22-27-35'3739 orbit, 2 - 1018 parotid gland, ,7 ' 33
pleura, 5 stomach, 32 ovary, 38 and liver, 25 and probably
the heart, 15 among other areas, have been the locations
of such lesions. These localized benign proliferations,
composed predominately of plasma cells and other
elements supported by fibrous stroma, are of unknown
etiology, and the terms "inflammatory pseudotumor,"
"post-inflammatory tumor," and "plasma cell gran-
uloma" provide no information about the essential
FIG. 4. Occlusive phlebitis in medium-sized veins in various stages (progression: upper left, upper right, lower left, lower right): inflammation
involving the vessel walls with gradual filling of the lumen, first with inflammatory cells, later with connective tissue rich in capillaries, and
finally, complete obliteration with total sclerosis. Hemotoxylin and eosin. x78.
SOMEREN A.J.C.P. . February 1978
180
especially these with sclerosing features, also have Bahadori and Liebow, 4 who prefer the designation of
similarities to invasive fibrous thyroiditis of Riedel, as "plasma cell granuloma" for inflammatory pseudo-
well as to idiopathic retroperitoneal fibrosis, and tumors of lung, reviewed 40 cases, in detail, and
mediastinal fibrosis, as was reported by others. 1 - 4 In concluded that these lesions are nonneoplastic, and
fact, various combinations of these fibrous processes have structural features and a natural history quite
have been described. 23 "Multifocal fibrosclerosis," as distinct from those of sclerosing hemangioma and
defined by Comings,'" and "multifocal idiopathic plasmacytoma.
fibrosclerosis," as defined by Uilman,:iti include: Portions of inflammatory pseudotumors of lung were
Riedel's thyroiditis, retroperitoneal fibrosis, mediastinal grown in tissue culture by Sherwin and associates,
fibrosis, sclerosing cholangitis, and pseudotumors of revealing growth in a granulomatous pattern, suggesting
the orbit, parotid gland, lacrimal glands, and lung. an inflammatory process. 31
The term "inflammatory pseudotumor" has been Electron microscopic studies of pseudotumors of the
used for a variety of chronic sclerosing inflammatory lung also revealed findings supportive of an inflamma-
processes in the orbit with no definite etiology but rather tory nature of these lesions, distinguishing them from
distinct histopathologic appearances. Included in this pulmonary sclerosing hemangiomas, malignant plasma
group are: lymphoid pseudotumors, plasma cell cell tumors, and pseudolymphomas. 719 ' 39
pseudotumors, orbital myositis, vasculitis, dacryo- Several investigators have observed inflammatory
adenitis, lipogranuloma, and sclerosing pseudotumors. 18 and obliterative changes in blood vessels in inflamma-
Weisenburger, Dennis I).: Interstitial pneumonitis associated with Department of Pathology, University
azathioprine therapy. Am J Clin Pathol 69:181-185,1978. A 24- of Iowa Hospitals and Clinics,
year-old female patient with rapidly progressive renal failure sec- Iowa City, Iowa
ondary to membrano-proliferative glomerulonephritis is thought
to have subsequently had acute interstitial pneumonitis as a conse-
quence of azathioprine therapy. The occurrence of the pulmonary
injury coincided with the rapid onset of severe renal failure
and was reversible with cessation of the drug. Accumulation
Received July 29, 1976; received revised manuscript November
15, 1976; accepted for publication November 15, 1976. of toxic metabolic products of azathioprine with subsequent
Address reprint requests to Dr. Weisenburger: Department of injury to the pulmonary interstitium is suggested as the etiol-
Pathology, University of Iowa Hospitals and Clinics, Iowa City, ogy. Azathioprine should be considered in the differential
Iowa 52242. diagnosis of interstitial pneumonitis in all patients taking the
0002-9173-78-0200—0181$00.75 © American Society of Clinical Pathologists