Journal of Liver Cancer

Case Reports

Rare Clinical and Radiologic Case of Cholangiocarcinoma Mimicking Pyogenic Abscess, Hepatic Echinococcal Cysts, and Metastases: Si Hyeong Lee, Soo Hyung Ryu, Dong Hoon Lee, Won Eui Yoon, Tae Young Park, Hye Kyung Lee, Jeong Seop Moon; J Liver Cancer. 2020;20(2):173-176. Published online September 30, 2020; DOI: https://doi.org/10.17998/jlc.20.2.173

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Cholangiocarcinoma is a biliary carcinoma with a wide spectrum of imaging, histological, and clinical features. In immunocompromised patients, pyogenic abscesses are relatively common and an echinococcal hepatic cysts are very rare. The authors experienced a very rare case of cholangiocarcinoma showing multiple hypodense masses with wall enhancement mimicking pyogenic liver abscess, echinococcal hepatic cyst, and cystic metastases. An 83-year-old man, complaining of fatigue and poor oral intake, presented to our outpatient clinic. Abdominal computed tomography (CT) revealed multiple, variable-sized hypodense masses with peripheral rim enhancement throughout the liver. Dynamic liver magnetic resonance images also showed findings similar to those of a CT scan. We performed ultrasound-guided biopsy of the mass which revealed cholangiocarcinoma.

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Surgical strategy for incidental intrahepatic cholangiocarcinoma in terms of lymph node dissection
Sung Hyun Kim, Dai Hoon Han, Gi Hong Choi, Jin Sub Choi, Kyung Sik Kim
Journal of Gastrointestinal Surgery.2024; 28(6): 910. CrossRef

A Case of Combined Hepatocellular-cholangiocarcinoma Mimicking Pyogenic Liver Abscess: Seung Suk Baek, Eileen L. Yoon, Hyun-Jung Kim, Kyung Eun Bae, Kyeongmee Park, Won-choong Choi; J Liver Cancer. 2017;17(2):174-181. Published online September 30, 2017; DOI: https://doi.org/10.17998/jlc.17.2.174

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Abstract PDF: Heterogeneous features of liver cancer can mimic liver abscess. Therefore it is essential to doublecheck tumor markers in the diagnosis of liver abscess. Herein, we report a case of combined hepatocellular-cholangiocarcinoma (cHC) occurred in an unrecognized chronic hepatitis B patient initially misdiagnosed as liver abscess. A 49-year old male initially presented with chill, right upper quadrant pain, and a liver mass. Mass showed peripheral enhancement in arterial phase of computed tomography, which was not typical for hepatocellular carcinoma (HCC). Strikingly elevated alpha-fetoprotein and fine needle aspirated pathology revealed HCC. Despite discordant image findings he was treated with transarterial chemoembolization. He was treated with sorafenib due to metastatic retrocaval lymphadenopathy afterwards. The mass presumed to be HCC progressed with sorafenib. It was surgically resected and he was finally confirmed as cHC. Discordant tumor markers with presumptive image findings should prompt the suspicion of rare type of primary liver cancer, the cHC.

A Case of Intractable Duodenal Ulcer Bleeding Followed by Hepatic Abscess after Transarterial Chemoembolization on Recurrent Hepatocellular Carcinoma: Keun Soo Ahn, Koo Jeong Kang, Young Hoon Kim, Tae Jin Lim; Journal of the Korean Liver Cancer Study Group. 2011;11(2):172-177. Published online September 30, 2011

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Abstract PDF: Transarterial chemoembolization (TACE) is widely used in patients with hepatocellular carcinoma (HCC). Although this procedure is being performed safely and effectively, severe complications including liver abscess, upper gastrointestinal bleeding and liver failure can be rarely occurred. A 63-year-old female patient was admitted due to hematochezia for 1 day. She underwent central bisectionectomy for HCC 3 months ago. On follow up computed tomography, large recurred HCC was found at left lateral section and she underwent TACE. Ten days after TACE, she complained anorexia, general weakness and hematochezia and admitted. On gastroduodenoscopy, diffuse and shallow ulcer with bleeding was noted at duodenal bulb and it was controlled by epinephrine injection. However, recurrent ulcer bleeding was occurred and she underwent a dozen times of endoscopic intervention and one time of angiographic intervention to control bleeding. Although ulcer bleeding was stopped, it was followed by liver abscess in the left lateral section. The abscess was drained by pig-tail catheter, however the patient resulted in dead by hepatic failure. It is hard to manage the severe complications after TACE, therefore TACE should be applied judiciously including super selection of hepatic artery and early detection of complications and appropriate management is necessary.

Liver Abscess after Percutaneous Radiofrequency Ablation for Hepatocellular Carcinomas: DH Kim Choi, EH Park, JH Lee, KC Koh, SW Paik, BC Yoo, DI Choi; Journal of the Korean Liver Cancer Study Group. 2005;5(1):75-77. Published online June 30, 2005

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Abstract PDF: During the past two decades, various image-guided tumor ablation techniques for the local control of malignant hepatic tumors have been developed. In comparison with surgical resection, the potential merits of these techniques involve the reduction of morbidity and the preservation of liver parenchyma. Hence, these techniques have largely replaced surgical resection for treating patients with hepatocellular carcinoma and poor hepatic functional reserve. Several previous reports have shown that radiofrequency ablation is superior to other local ablation technique, such as ethanol or microwave ablation therapy. Even though percutaneous radiofrequency ablation is considered a safe treatment modality, the a variety of complications have been reported. Of these, liver abscess is one of the most common complications. Here, we present a patient diagnosed as liver abscess after RF ablation procedure for treating hepatocellular carcinoma.

Eosinophilic Liver Abscess - Preoperatively Misdiagnosed as a Hepatocellular Carcinoma -: Seok Ho Choi, Kyu Eun Lee, Nam-Joon Yi, Choon Hyuck Kwon, Young Moon Jang, Seong Hwan Jang, Kyung-Suk Suh, Kuhn Uk Lee; Journal of the Korean Liver Cancer Study Group. 2003;3(1):69-72. Published online July 31, 2003

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Abstract PDF: A 43-year-old man was admitted with the known liver mass with eosinophilia. He had a 2 cm-sized liver mass in the lateral segment of liver. The mass had a high attenuation in arterial phase and low attenuation in portal phase. He underwent laparoscopy-assisted hepatic resection with the impression of hepatocellular carcinoma. The pathologic diagnosis was eosinophilic abscess postoperatively. The etiology was Toxocara diagnosed with th aid of enzyme-linked immunosorbent assay.

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