Case Report
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World J Gastrointest Surg. Feb 27, 2014; 6(2): 33-37
Published online Feb 27, 2014. doi: 10.4240/wjgs.v6.i2.33
Rare diaphragmatic tumor mimicking liver mass
Shalini Thapar, Arvind Ahuja, Archana Rastogi
Shalini Thapar, Department of Radiodiagnosis, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Arvind Ahuja, Archana Rastogi, Department of Hepatopathology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Author contributions: Thapar S made substantial contributions to the conception and design, acquisition, analysis and interpretation of data, and drafted the article and helped in final approval of the version to be published; Ahuja A and Rastogi A helped in critically revising the article for important intellectual content and contributed to the conception, design, acquisition, analysis and interpretation of data; and Ahuja A helped in drafting the article.
Correspondence to: Shalini Thapar, Associate Professor, Department of Radiodiagnosis, Institute of Liver and Biliary Sciences, Sector D-1 Vasant Kunj, New Delhi 110070, India. thaparshalini@gmail.com
Telephone: +91-981-0757973 Fax: +91-981-0757973
Received: May 12, 2013
Revised: December 12, 2013
Accepted: January 13, 2014
Published online: February 27, 2014
Abstract

Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the commonest malignant neoplasms of the diaphragm; however, only a few (less than 20) cases have been reported to date. We present the case of an extremely rare tumor of the diaphragm mimicking a liver mass. The patient, a young 28-year-old woman, presented with an 8-month-history of mildly progressive upper abdominal pain and early fullness after meals. Computed tomography scan of the abdomen revealed a mass located in the region of the left lobe of the liver with non visualized left lobe and partial vascular supply of the mass from the left hepatic artery. The tumor was also seen to draw its vascularity from bilateral internal mammary arteries. Surgical excision and hepatectomy was planned, keeping in mind the diagnosis of an atypical left hepatic mass. Laparotomy revealed a left diaphragmatic tumor growing caudally into the upper abdomen, compressing and splaying the liver along the left medial surface where the tumor was virtually adherent to it. Successful excision of the mass and subsequent histopathological and immunochemistry examination of the specimen revealed low grade fibromyxoid sarcoma of the diaphragm. This case highlights the unusual presentation of a diaphragmatic mesenchymal tumor and how it can be mistaken as an atypical liver mass. It also emphasizes the tumoral vascular supply as an indicator of its organ of origin.

Keywords: Diaphragmatic tumor, Low grade, Fibromyxoid sarcoma, Liver mass, Atypical liver mass, Computed tomography

Core tip: In this paper, a patient with low grade fibromyxoid sarcoma of the diaphragm which mimicked a liver mass on preoperative imaging is reported. Particular attention is paid to retrospective analysis of the vascularity of the mass on computed tomography angiography to differentiate it as an extrahepatic mass. The histopathological analysis of this case, as well as a collective review, is also presented in this report.