Ruptured hepatic sarcoma as a cause of acute abdomen

Area of Science:

• Hepatology
• Surgical Oncology
• Pathology

Background:

• Liver tumors can present with life-threatening complications such as hypovolemic shock.
• Early diagnosis and surgical intervention are crucial for managing aggressive hepatic malignancies.

Observation:

• A 24-year-old male presented with hypovolemic shock and anemia due to a large, ruptured liver tumor in segments II and III.
• Imaging revealed an 11.8x11.7cm expansive lesion with signs of rupture, necrosis, and intra-abdominal hemorrhage.
• Standard tumor markers and viral serology were negative.

Findings:

• Exploratory laparotomy confirmed a 20x20cm multilobed tumor dependent on hepatic segments II and III with significant intra-abdominal bleeding.
• Histopathological examination identified a non-classifiable high-grade sarcoma, positive for CD56.
• A R2 surgical resection was achieved, followed by patient discharge within 7 days.

Implications:

• This case underscores the diagnostic challenge posed by rare, aggressive liver sarcomas that may not conform to typical tumor marker profiles.
• Prompt surgical management, including hepatic segmentectomy, is vital for controlling hemorrhage and achieving tumor debulking in such critical presentations.
• Further research into the specific characteristics and optimal treatment strategies for CD56-positive, non-classifiable hepatic sarcomas is warranted.