Primary leiomyoma of the liver in an immunocompetent patient

Abstract

Primary leiomyoma of the liver (PLL) is a rare benign tumor occurring in immunosuppressed people. From 1926 less than fifty cases are reported in the scientific literature and about half are in immunocompetent patients. Etiology of this kind of lesion is not yet well known. We report a case of primary hepatic leiomyoma in a 60-year-old immunocompetent woman. The patient presented with lipothymia with unexpected vomiting. She underwent an ultrasound (US), and a computed tomography (CT) scan that revealed the presence of a single, solid lesion about 9 cm located between the S5 and S8 segment of the liver. It showed a well-defined, heterogeneous hypodensity with internal and peripheral enhancement and various central hypoattenuating areas and no wash-out in the portal and the late phases. Because of her symptoms and the risk of malignancy, the patient underwent a surgical liver resection. Histological diagnosis was primary leiomyoma of the liver. The patient had an uneventful recovery and was discharged after 7 days. At 30 months follow-up there were no symptoms and no evidence of disease. Leiomyoma of the liver is a rare benign neoplasm of which clinical symptoms are nonspecific and the exact radiological diagnosis still remains a challenge for radiologists. Etiology is still unclear and usually PLL represents an incidental diagnosis. Surgery plays a primary role not only in the treatment algorithm, but also in the diagnostic workout.

Primary Hepatic Leiomyoma in a Healthy Middle-Aged Woman: Literature Review and Case Report

“…To date, only one successful preoperative diagnosis of PHL has been reported by Sousa et al (14). At first, they were unsuccessful with US-guided fine needle aspiration (FNA) due to insufficient material, which was consistent with previous and later studies (6,19). Subsequently, however, they managed to achieve preoperative diagnosis of PHL with a 18G FNTB of the liver lesion (14).…”

“…Besides the tumor being composed of smooth muscle cells, distant leiomyomas elsewhere in the body must be excluded. Since it was first described in 1926 by Demel et al ( 5 ), less than 50 cases of PHL have been reported in medical literature with only 24 cases among immunocompetent patients ( 6 ).…”

“…Generally, surgical site infections and incisional hernias occur with higher frequencies in immunocompromised patients, in which PHL is also more common. Therefore, minimally invasive liver resection (either laparoscopic or robotic) could be particularly beneficial in these patients as it has been associated with lower rates of postoperative wound complications ( 6 , 18 ). Nonetheless, since tumor was located in posterolateral segment of the liver, we chose to proceed with open liver resection.…”

Asymptomatic Hepatic Leiomyoma in an Immunocompetent Middle-Aged Woman

“…7 Among all reported cases, only 24 cases were among immunocompetent patients. 8 PHL diagnostic criteria as described by Hawkins et al require that the tumor in question originates from hepatic mesenchymal tissue and that there are no primary tumors elsewhere in the body including the urogenital organs. 4 Histologic evidence of primary spindle cells, bundles of smooth muscle cells, and eosinophilic cytoplasm are ideal for accurate diagnosis.…”