A Rare Liver Tumour and Rather Rare Biopsy Complication

Abstract

FigureFigurePrimary hepatic leiomyosarcoma is a rare tumour of the liver. It usually arises from intrahepatic vascular structures, bile ducts or ligamentum teres. We present a patient who presented with right upper quadrant mass and died of post-liver biopsy haemorrhage. Primary hepatic leiomyosarcoma was diagnosed on autopsy. A 67 year old Caucasian woman presented to her primary physician with a three week history of abdominal pain in June 2006. She was taking aspirin, and atorvastatin. She drank little alcohol and did not use any other drugs. Examination, including breast, was unremarkable apart from a 20 cm firm, non-tender hepatomegaly. She had normocytic anaemia. Liver tests and viral serology for Hepatitis B and C were normal. Tumour markers were normal. An USS scan of the abdomen revealed an 18 cm right upper quadrant mass arising at the level of the liver. She went on the have contrast CT scan of the liver, which confirmed a mass arising from the right lobe of the liver (Fig. 1) with at least two other lesions arising from segment four and the left lobe, raising the likely possibility of hepatocellular carcinoma. An USS-guided liver biopsy was non-diagnostic and the patient, unfortunately, suffered a terminal haemorrhage following the procedure. Autopsy was carried out and histology of hepatic mass confirmed the lesion to be primary liver leiomyosarcoma (Fig. 2). Primary hepatic leiomyosarcoma although rare should be considered in the differential diagnosis of patients with large hepatic mass in absence of cirrhosis and other risk factors for hepatocellular carcinoma. Furthermore it highlights the still appreciable biopsy related morbidity and mortality, particularly in patients with large hepatic masses.[figure1][figure2]