Here, we describe the case of a 65-year-old woman who presented with a huge cystic lesion in the liver. Laboratory studies performed on admission showed modest
inflammation, poor nutrition, and elevated levels of total
bilirubin,
alkaline phosphatase, and γ-glutamyl
transferase. Computed tomography showed a well-defined, heterogeneous
tumor with multiple
cysts involving the right lobe and the medial segment of the liver, with a maximum diameter of 16 cm. Positron emission tomography/computed tomographic scans showed the uptake of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose in a part of the
cyst. The patient was diagnosed with
mucinous cystadenocarcinoma or
sarcoma of the liver and underwent right trisectionectomy. Histopathological studies revealed that the
tumor was composed of pleomorphic and polynuclear dyskaryotic cells with eosinophilic globules in the cytoplasm. Mesenchymal
hamartoma-like tissue was observed in the peripheral part of the
tumor. Immunohistochemical analyses showed the
tumor stained with
vimentin, α-smooth muscle actin,
desmin, α1-antitrypsin, and α1-antichymotripsin. Therefore, a histological diagnosis of UESL was made. Eighteen months following treatment, two recurrent
tumors in the remnant liver were detected and resection of the recurrent
tumors was performed.
CONCLUSIONS: A UESL should be considered in the differential diagnosis of large cystic hepatic lesions. Although the prognosis of UESL is extremely unfavorable, aggressive surgical resection should be the most important factor for ensuring long-term survival.