Primary leiomyosarcoma of the liver mimicking liver abscess

Primary hepatic leiomyosarcoma is a rare tumor, with fewer than 60 previously reported cases. The usual clinical presentation is painful hepatomegaly or a painful epigastric mass. We present the case of a 64-yr-old white man who presented with fevers, drenching night sweats, fatigue, leukocytosis, an elevated erythrocyte sedimentation rate, and an indistinct mass in the right lobe of his liver on CT scan. Although the clinical presentation was suggestive of hepatic abscess, a percutaneous biopsy was consistent with a smooth muscle tumor. Successful right hepatic lobectomy resulted in resolution of all the associated symptoms and signs. A review of the world literature produced 44 papers reporting a total of 54 cases. The male:female ratio was 25:26; mean age was 53.6 yr. The tumor tended to occur at an earlier age in women, with a group mean age of 49.0 yr compared with 58.4 for men. It was more common in the right lobe. Metastatic disease was present in 40.9% of patients. The outcomes for various therapeutic approaches were compared. Patients treated with comfort measures alone had a mean survival or follow-up of 0.87 yr. The best outcome seemed to be in those patients treated with a combination of surgery and chemotherapy, with a mean survival or follow-up of 3.3 yr.