Case of primary hepatic leiomyosarcoma successfully treated with laparoscopic right hepatectomy

Abstract

We describe the case of a 77-year-old woman, presenting with non-specific epigastric pain. Physical examination and subsequent imaging revealed the presence of a large mass in the right liver lobe. This was shown to be a leiomyosarcoma on biopsy histology. Further investigation confirmed this to be a primary hepatic leiomyosarcoma with no evidence of metastases. The patient underwent successful surgical resection. She is currently under imaging follow-up, with no evidence of disease recurrence.

Keywords: hepatic cancer; liver disease; pathology; surgical oncology.

Figure 1

Coronal (A) and axial (B) portovenous phase CT images of the abdomen demonstrate a partially solid/partially cystic large mass measuring 19.8×16.8×14.9 cm occupying most of the right liver lobe.

Figure 2

Fluorodeoxyglucose (FDG)-PET/CT scan demonstrating a sizeable focus of intense accumulation of radiolabelled glucose corresponding to the known hepatic leiomyosarcoma occupying most of the right liver lobe. Large central photopaenic areas within are in keeping with tumour necrosis.

Figure 3

Fat-suppressed T1-weighted MR images at two levels in the upper abdomen, acquired in the precontrast (A), arterial (B) and portovenous (C) phases. Note is made of high-grade necrosis within the lesion together with peripheral enhancement. No satellite lesions are demonstrated.

Figure 4

Coronal (A) and corresponding axial (B) T1-weighted MR images in the hepatobiliary phase demonstrating peripheral enhancement. Axial T2-weighted image (C) demonstrates areas of central hypointensity corresponding to previous bleeding. Diffusion-weighted imaging, b=50 (D) and b=800 (E) shows restricted diffusion.

Figure 5

Representative histology images; H&E ×20 (A) and smooth muscle marker desmin ×10 (B) demonstrating neoplastic, variably atypical spindled smooth muscle cells with cigar-shaped nuclei, organised in whorls and fascicles. Immunohistochemical staining for desmin is positive.

Figure 6

Coronal T2-weighted representative image from the surveillance MRI done 8 months following surgery, which showed no evidence of disease recurrence.