Inflammatory pseudotumor of the liver misdiagnosed as metastatic tumor of nasopharyngeal carcinoma : a typical case report of mistreatment caused by anchoring bias

Zejin ZhaoJian-Li WangYue XiaoMiaohang CuiJian LiJing Ma^*

• Affiliated Hospital of Chengde Medical University, Chengde, China

This case report describes the clinical process of a patient with a history of nasopharyngeal carcinoma who was misdiagnosed as metastatic tumor, later confirmed as inflammatory pseudotumor. The patient was a 68-year-old male who was diagnosed with nasopharyngeal carcinoma 4 years ago. The condition was well controlled after regular radiotherapy and chemotherapy. One year ago, a solid mass was found in the left lateral lobe of the liver during routine follow-up. MRI suggested nasopharyngeal carcinoma metastasis. Later, MRI in Peking Union Medical College Hospital also suggested nasopharyngeal carcinoma metastasis. Intrahepatic cholangiocarcinoma was not excluded, and surgical treatment was recommended. Preoperative biopsy was recommended by the multidisciplinary team; however, the patient declined due to financial constraints and personal preference. The patient underwent laparoscopic left lateral hepatectomy and hilar lymph node dissection in the Affiliated Hospital of Chengde Medical College. Postoperative pathology showed a large number of neutrophils, lymphocytes and eosinophils infiltration, no malignant components, considered as inflammatory pseudotumor. The diagnosis was further confirmed by pathological review and immunohistochemistry in Peking Union Medical College Hospital. The patient recovered well after operation, and there was no recurrence after 1 year of follow-up. This case suggests that in patients with a history of malignant tumors, when imaging is highly suspicious of tumors, we should still be alert to infectious lesions and avoid anchoring bias. Preoperative biopsy and multidisciplinary comprehensive evaluation ( MDT ) can help to clarify the diagnosis and reduce misdiagnosis and overtreatment.