Hepatocellular Carcinoma Mimicking Liver Abscesses in a Cirrhotic Patient with Severe Septic Shock as a Result of Salmonella O9 HG Infection

Abstract

We describe a case of severe Salmonella O9 HG sepsis with a mass in the liver, which was diagnosed as hepatocellular carcinoma (HCC) by autopsy of the liver. The patient was a 67-year-old man with chronic high blood pressure. In addition, he was an alcoholic and had been drinking every day for many years. He had had a dinner of ‘sukiyaki’ with a raw egg two days before admission. The next morning, he had developed vomiting, diarrhea, and abdominal pain. Salmonella O9 HG was found in the blood and stool cultures. In the computed tomography (CT) finding of the liver, there was a 2 cm early-enhanced mass with a multilocular structure, with ringed enhancement and daughter nodes. Since we thought that the mass was a liver abscess, we performed needle aspiration from the liver mass and were able to withdraw blood. Despite adequate antibiotic treatment, the patient died as a result of complications on the 55th day after admission. After the patient’s death, we conducted an autopsy. There were two HCC masses, a moderately-differentiated and a well-differentiated mass, as a result of alcoholic cirrhosis of the liver. As the HCC had multilocular cyst-like structures, which were fiber- and necrosis-rich, CT images of the liver masses resembled abscesses.

Steato-hepatitic HCC with cystic degeneration mimicking as hydatid cyst

“…9 The imaging pattern is thought to be related to the pathologic features of central necrosis and surrounding residual malignancy. 10 In addition, the imaging findings of a cystic tumor of the liver are similar to those of peliotic HCC in terms of multisite and peripheral enhancement. A thin septum and variable calcification are strongly suggestive of a cystic tumor of the liver rather than classic HCC.…”

Cystic Degeneration of Hepatocellular Carcinoma Mimicking Mucinous Cystic Neoplasm

“…9 The pattern of images is believed to be a linkage to the pathologic features of central necrosis and remnant surrounding malignant cells. 10 Moreover, the image findings of mucinous cystic neoplasm of the liver are similar to cystic HCC in the view of multiloculation and peripheral enhancement. Fine septation and variable calcification strongly suggest a mucinous cystic neoplasm of the liver rather than cystic HCC.…”

Liver Abscesses as Pseudotumoral Lesions

“…In most cases, salmonellosis is nowadays promptly diagnosed, but there are rare situations where liver abscess caused by Salmonella may be attributed to other types of hepatic mass-forming lesions. In patients with septic salmonellosis, hepatic malignancies may mimic (expected) liver abscesses, as the necroses that develop in malignant tumors may resemble cavitated Salmonella abscesses on CT images (Hagiwara et al 2009). Conversely, liver abscesses in septic salmonellosis may be confounded with multiple hepatocellular carcinomas (Simmers et al 1997).…”