In the past 26 years we have encountered five patients with primary liver malignancy clinically characterized by high remittent fever and leukocytosis mimicking liver abscess. Two patients underwent exploratory laparotomy, and drainage was carried out in another. The clinical courses went rapidly downhill. The liver was cirrhotic in two patients. The interior of the main mass was almost totally necrotic in four cases. Histologically, the malignant cells in the main portion resembled sarcoma, but in some areas cells appeared epithelial with eosinophilic cytoplasm and were in a trabecular arrangement, except for one case not subjected to autopsy in which histological study was inadequate because of extensive necrosis. It seems that these neoplasms were very poorly differentiated hepatocellular carcinomas rather than combinations of sarcoma and hepatocellular carcinoma. These patients, therefore, may represent a distinct clinicopathological type of hepatocellular carcinoma that is very rare in Japan but perhaps more common in South Africa, where similar cases have been clinically described in larger numbers.
A case of solitary tuberculoma of the liver is reported, together with a review of the literature. A 48-year-old female visited our hospital with the chief complaint of right lateroabdominal pain. Examinations on admission revealed a lack in inflammatory findings and all tumor markers in normal ranges. Abdominal ultrasonography and CT indicated an irregular tumorous lesion in the border region between S5 and S6 of right lobe of the liver. Ultrasonography-guided biopsy of the liver offered a suspision of liver cell carcinoma, and hepatectomy was carried out. Extirpated specimen was a well-defined and yellowish brown solid tumor, associating with a cavitation partially in the center. It was considered an inflammatory tumor. Pathohistologically almost of the tumor was consisted of coagulated necrosis surrounded by epitheloid cell layer containing Langhans giant cells in the outside of which infiltrated lymphocytes and plasma cells were seen. Ziehl-Neelsen staining resulted in negative, however, solitary tuberculoma was strongly suspected for its morphology. Postoperative course was uneventful. The patient is strictly followed without any antituberculosis treatments.
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