A case of mistaken identity: Gallstone-induced hepatic abscess mimicking metastasis

Abstract

We present a challenging case at our facility involving a 70-year-old female with a history of hypertension who was diagnosed with malignant ovarian neoplasia. Preoperative imaging revealed a 6 x 6 x 2.5 cm mass in liver segment 6, initially suspected to be metastatic disease. The patient had undergone a laparoscopic cholecystectomy 11 years prior. Despite repeated biopsies and a high fluorodeoxy-glucose (FDG) uptake value of 9.87 on positron emission tomography-computed tomography (PET-CT), the exact nature of the mass remained undetermined. However, during a total abdominal hysterectomy and bilateral salpingo-oophorectomy, an excisional biopsy of the liver lesion identified it as an abscess formed around a gallstone, presumably spilled during the previous cholecystectomy. This case highlights a rare but significant diagnostic challenge, wherein a gallstone shed during gallbladder surgery mimicked a metastatic liver mass. It underscores the importance of considering a patient's surgical history in differential diagnoses, especially when encountering atypical abdominal masses.

Figure 1

CT Scan: (a) Axial plane. (b) Coronal plane.

Figure 2

PET-CT Scan: (a) Axial plane (b) Coronal plane.

Figure 3

Macroscopic view of specime.

Figure 4

Histopathological examination: There is considerable dense infiltrate of polymorphous leukocytes, plasma cells, and macrophages, some multinucleated. (HEx10)