Primary hepatic leiomyosarcoma presenting as a thick-walled cystic mass resembling a liver abscess

Abstract

Rationale:Hepatic leiomyosarcoma is a rare malignant tumor, and in rare instances, its combination with fever may lead to misdiagnosis of liver abscess. In our case, the presence of the tumor was considered by the presence of blood vessels through the observation of hepatic tumor wall.Patient concerns:A 38-year-old woman who had been diagnosed with a liver abscess in a local hospital consulted our institution by complaining left upper quadrant pain and fever. The diagnosis was questioned in our workup, since no obvious inflammatory marker was found in the circulation, and contrast-enhanced computed tomography revealed a huge thick-walled mass in the right liver with multiple tortuous vessels within the wall.Diagnosis:Imaging revealed a neoplastic lesion rather than liver abscess. The enhancement of the solid tumor tissues was reduced during the portal phase and delayed phase, which was consistent with a wash-out enhancement. The histopathologic and immunohistochemical results confirmed the diagnosis was primary hepatic leiomyosarcoma. A pulmonary nodule during the postoperative follow-up was diagnosed as metastatic leiomyosarcoma tumor through surgery.Interventions:A right hepatectomy was performed to cure the hepatic mass. In the follow-up, a metastatic tumor in the lung was resected, followed by chemotherapy.Outcomes:Lung metastasis and liver recurrence occurred at 25 and 39 months after liver surgery, respectively. Then the patient was lost to follow-up.Lessons:Leiomyosarcoma is associated with a dismal prognosis, but outcomes for these patients may be improved by the combined surgical resection and chemotherapy.

Case of primary hepatic leiomyosarcoma successfully treated with laparoscopic right hepatectomy

“…Review of the literature reveals only about 76 cases of primary hepatic leiomyosarcoma reported 3–63. As in our case, an important prerequisite to its diagnosis is to exclude the possibility of an extrahepatic source of metastasis, with primary tumours being typically identified in the gastrointestinal tract, uterus or retroperitoneum 64–67…”

Imaging Findings of Hepatic Ewing’s Sarcoma on Computed Tomography and Gadobenate Dimeglumine-enhanced Magnetic Resonance Imaging: A Case Report and Literature Review

“…28 The patient ages at the time of tumor detection ranged from 5 months to 86 years, with no obvious sex difference. [29][30][31][32] On CT, the tumors are hypodense, with necrosis or bleeding, and heterogeneous enhancement. On MRI, the tumors are hypointense on T1WI and heterogeneous hyperintense on T2WI with heterogeneous enhancement.…”

Metastatic neuroendocrine tumor masquerading as liver abscesses

“…Similar case reports where lesions earlier thought to be malignant or metastatic lesions eventually diagnosed as pyogenic, 20 tubercular, 21 syphilitic, 22 toxocariasis, 23 amebic, 24 and actinomycosis 25 liver masses have been reported. Other case reports have cited initial infectious-appearing liver lesions eventually being diagnosed as neoplastic lesions, [26][27][28] including neuroendocrine tumor. 29,30 Neuroendocrine tumors (NET), traditionally referred to as carcinoid tumors, are neuroendocrine cell neoplasms originating from various organ systems such as the gastrointestinal tract, lung, pancreas, and genitor-urinary organs.…”