Primary Hepatic Leiomyosarcoma with Giant Cyst Formation : A Case Report

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A 64-year-old male with right upper abdominal pain had been treated with an H₂-blocker for three months as a gastric ulcer recurrence with no response. An abdominal US identified a large cystic tumor in the left lobe of the liver. Tumor markers were all normal ; hepatitis serology tests were all negative, although liver function tests were elevated slightly. A CT scan showed a well-defined cystic tumor with a thick, heterogeneously enhanced wall. Selective celiac artery angiograms showed displacement of the common hepatic artery, and an avascular area. As a malignant tumor was suspected, a left lobectomy of the liver was performed. The tumor measured 17×15×12cm and contained central cystic degeneration filled with 280 ml of dark red fluid. Microscopic findings revealed anaplastic spindle cell proliferation, and immunohistochemical examination was positive for α-smooth muscle actin. A thorough survey did not detect a primary tumor in any other organ. Therefore, primary hepatic leiomyosarcoma was diagnosed. Only 80 cases have been reported. We reviewed the available literature.