Xanthogranulomatous inflammatory pseudotumour of the liver mimicking malignancy

Inflammatory pseudotumour of the liver (IPTL) is a rare benign lesion that can closely mimic hepatic malignancy on imaging and laboratory testing. We describe a patient who presented with fever, abdominal discomfort, weight loss and raised inflammatory markers. Initial imaging suggested a hepatic abscess, but subsequent scans demonstrated a lobulated hypodense lesion with peripheral enhancement and venous washout, raising concern for malignancy. Tumour markers showed elevated CA 19-9 levels. Core biopsy confirmed xanthogranulomatous inflammation with stromal smooth muscle actin (SMA) positivity and absence of malignant hepatocellular markers. The patient was managed conservatively with corticosteroids alongside therapy for the underlying metabolic dysfunction-associated steatotic liver disease (MASLD). Serial follow-up demonstrated progressive regression on imaging, with resolution of symptoms. This case highlights the importance of recognising inflammatory pseudotumour in the differential diagnosis of hepatic masses and the value of core biopsy in avoiding unnecessary hepatic resection.