Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2022; 14(4): 860-865
Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.860
Not all liver tumors are alike — an accidentally discovered primary hepatic leiomyosarcoma: A case report
Isabel Garrido, Patrícia Andrade, João Pacheco, Elisabete Rios, Guilherme Macedo
Isabel Garrido, Patrícia Andrade, Guilherme Macedo, Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto 4200-319, Portugal
Isabel Garrido, Patrícia Andrade, Guilherme Macedo, World Gastroenterology Organization Porto Training Center, Porto 4200-319, Portugal
João Pacheco, Elisabete Rios, Pathology Department, Centro Hospitalar Universitário de São João, Porto 4200-319, Portugal
Author contributions: Garrido I drafted the manuscript; Garrido I, Andrade P, Pacheco J, Rios E and Macedo G have revised and finalized the manuscript; All authors have approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors have no disclosures to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Isabel Garrido, MD, Doctor, Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal. isabelmng@hotmail.com
Received: January 10, 2022
Peer-review started: January 10, 2022
First decision: January 22, 2022
Revised: January 22, 2022
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 27, 2022
Processing time: 101 Days and 11.8 Hours
Abstract
BACKGROUND

Primary hepatic leiomyosarcoma is a very rare entity that originates from smooth muscle. Preoperative diagnosis requires a high degree of suspicion due to atypical clinical presentation and non-specific imaging features.

CASE SUMMARY

We report the case of a 42-year-old man, with no relevant past medical history, accidentally diagnosed with a nodular liver lesion on a routine abdominal ultrasound. Liver function tests and hematology parameters as well as tumor markers were normal. A contrast-enhanced abdominal computed tomography scan revealed a heterogenous hepatic lesion measuring 40 mm 30 mm, adjacent to the left branch of the portal vein and the round ligament. Due to the unclear diagnosis, the patient underwent surgical resection. Histopathological and immunohistochemical examinations confirmed complete (R0) resection of a hepatic leiomyosarcoma. The patient remains without any signs of tumor recurrence for more than 2 years.

CONCLUSION

We report a rare case of accidentally diagnosed primary hepatic leiomyosarcoma originating from the portal vein or the round ligament. Although this tumor has aggressive metastatic potential, a tumor-free resection margin is essential to improve survival.

Keywords: Primary hepatic leiomyosarcoma; Portal vein; Round ligament; Surgical resection; Case report

Core Tip: Sarcomas comprise only 1%-2% of all primary liver malignancies, and leiomyosarcoma is even rarer. We report a rare case of primary hepatic leiomyosarcoma accidentally diagnosed and surgically treated. The diagnosis requires a high level of suspicion because the clinical scenario and cross-imaging are not specific. Thus, histological examination is the only way to reach the diagnosis. In our case, the tumor probably originated from the left branch of the portal vein or the round ligament. Radical hepatectomy is the cornerstone of treatment. However, this tumor has aggressive metastatic potential and is usually diagnosed in locally advanced or metastatic disease. Two years after surgical resection, our patient is alive and with no evidence of tumor recurrence, likely because the diagnosis was established at an early stage and the surgery achieved a tumor-free margin.