Primary hepatic leiomyosarcoma presenting as a thick-walled cystic mass resembling a liver abscess: A case report

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.

Figure 1

(A) Nonenhanced computed tomography (CT) scan showing a large heterogeneous tumor of the right liver with ill-defined edges. A contrast-enhanced CT scan indicated significant heterogeneous enhancement of the mass, with multiple wrapped vessels within the wall during the arterial phase (B). The enhancement of solid components decreased during the portal venous phase (C) and delayed phase (D). The unenhanced region of the tumor was confirmed to be necrosis.

Figure 2

(A) The tumor consisted of uniformly sized spindle-shaped neoplastic cells. Heterogeneous nuclei and multinucleated giant cells were found (hematoxylin and eosin, ×100). Immunohistochemistry-indicated leiomyosarcoma cells were VM+ (B) and SMA+ (C) (×100).