Primary hepatic leiomyosarcoma (PHL) is a very rare primary liver tumour. These tumours usually arise from intrahepatic vascular structures, gallbladder, or ligamentum teres. The pathogenesis of this disease is still unknown. We report a 53-year-old man with complaints of intermittent right upper abdominal pain for one month, decreased appetite, nausea, weight loss, and tea-coloured urination. The patient denied any complaints of defecation pattern. On physical examination, jaundice was present in both eyes and the whole-body skin, tenderness in the right hypochondriacal region, and enlarged liver with a lumpy surface. The laboratory examination demonstrated increased transaminase enzymes and bilirubin, while hepatitis B and C were negative. The patient underwent several tests for tumour markers, such as CA 19-9 50 (<37 U/mL), AFP 1.23 (<5.81 IU/mL), and CEA 0.83 (<3 ng/mL). Ultrasound demonstrated an enlarged liver, multiple liver nodules, and cholelithiasis. Meanwhile, the abdomen’s computerised tomography (CT) scan shows a solid heterogeneity image with an irregular border in segments 1 and 4b and a tumoral thrombus in the inferior vena cava. The diagnosis was confirmed by biopsy and immunohistochemistry (IHC); vimentin and smooth muscle actin (SMA) results were positive, while CD 34, CD 117, and cytokeratin were negative. Our patient was diagnosed with PHL stage IVa (T4N2M0). PHL is a particularly rare tumour with a poor prognosis. The patient died after one month of diagnosis. Diagnosis of PHL is challenging. It was based on clinical features, physical examinations, laboratory examinations, and other supporting investigations.

Pancreatic cancer is difficult to diagnose in early stage. Malignant bile duct obstruction is a severe complication of pancreatic cancer, which can lead to poor outcomes including cholangitis, delayed treatment, reduced quality of life, and increased mortality. Perendoscopic placement of stents is a method widely used in the management of various malignant and benign pancreatico-biliary abnormalities. A 70-year-old woman came to Dr Moewardi General Hospital in Surakarta with the chief complaint of yellowish skin and eyes since one month before hospital admission. Patient was diagnosed with obstructive jaundice due to suspected of advanced stage pancreatic cancer. Subsequently, patient underwent endoscopic retrograde cholangiopancreatography (ERCP) which revealed an intrahepatic and extrahepatic bile ducts dilatation due to pancreatic tumor which infiltrated common bile duct, thus self expandable metallic stent (SEMS) placement was performed. Furthermore, patients received palliative therapy due to inadequate chemotherapy requirement.