Hepatic leiomyosarcoma

Case contributed by Dr Matt A. Morgan

Presentation

Right upper quadrant pain for two months

Patient Data

Age: 40-50 Y
Gender: Female
Modality: CT

Heterogeneous attenuation 14 cm mass in the right hepatic lobe, with predominantly low attenuation.  There is mild, patchy enhancement in the lesion.

Stranding at the anterior, inferior surface of the liver, extending into the omentum and peritoneal space is suggestive of rupture.

Modality: MRI

An MRI of the abdomen shows the mass to have a heterogeneous appearance, with cystic components and heterogeneous enhancement.

Modality: Nuclear medicine

The hepatic lesion is markedly hypermetabolic, with an SUV of 10.2 (background liver is 1.4)

Case Discussion

Hepatic leiomyosarcoma is a rare primary tumour, with approximately 30-50 cases recorded. The tumour is thought to arise from smooth muscle cells in bile ducts or blood vessels, and has not been associated with cirrhosis.

The case above was resected (right hepatectomy) following the imaging findings. When the tumor was exposed, frank perforation and hemorrhage was noted, concordant with the images above (this finding has been described in other hepatic leiomyosarcomas). There was no carcinomatosis.

Pathologic analysis revealed a leiomyosarcoma penetrating through the liver capsule.

This case may be the first demonstrating a hepatic leiomyosarcoma on PET-CT. Of note, the marked metabolic activity appears slightly discordant with the lack of avid enhancement in the tumor. 

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Case Information

rID: 31892
Case created: 3rd Nov 2014
Last edited: 18th Nov 2016
Tag: liver
Inclusion in quiz mode: Included

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