A 65-year-old male presented with abdominal pain of one month duration, more intense in the right hypochondrium, nausea, without fever or other symptoms.
It has multiple cardiovascular risk factors without previous liver diseases.
Abdominal examination revealed pain on palpation of the right hypochondrium without visceromegaly or signs of peritoneal irritation.
Blood analysis showed no change in hemoglobin, liver function or elevation of acute phase reactants.
Neither hepatitis nor alpha-fetoprotein serology was determined.
Ca 19.9 was normal.
Abdominal ultrasound and CT revealed a rounded and heterogeneous lesion in the right liver lobe, adjacent to the gallbladder fundus, with an 8 cm enhanced wall, which suggested differential diagnosis with an infectious cystadenocarcinoma or complicated hepatic lesion.
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In the preoperative period, a new CT was performed due to an increase in abdominal pain, with the objective of finding a multilayer cystic lesion growth of the IVB segment and imprinting the gallbladder, about 12 cm.
During surgery, a tumor of about 10-15 cm was observed, dependent on segment IV-B, with an intracystic solid component suggestive of cystadenocarcinoma.
He also had a cystic part adhered to the abdominal wall, mesocolon, duodenum and contacted the gallbladder.
Cystic zone rupture occurred during dissection maneuvers, of which 500 cc of clear fluid were drained for cytological study.
Completed with resection of the tumor mass, cholecystectomy and limited liver resection requiring 10 minutes of hiliar clamping.
1.
The postoperative period was satisfactory and without complications.
She was discharged on postoperative day 5.
Although cytology of ascitic fluid was negative for tumor cells, the anatomopathological diagnosis was adult epithelial hepatoblastoma, undifferentiated small cell subtype, with areas of embryonic and fetal differentiation.
The surgical margin was free, with no lymphatic, vascular or perineural invasion.
A control CT scan 5 months after surgery showed a multilayered low density lesion in the resection bed classified as local recurrence, with no data on distant disease.
The patient underwent surgery with excision of the recurrence, peritonitis of the right upper quadrant and right hemicolectomy.
Finally, 5 months after the first relapse and 10 months after diagnosis, she was readmitted for abdominal pain and was diagnosed by CT of a new abdominal relapse, unresectable, with bilateral hepatic lesions, peritoneal and asc.
Due to the poor general condition, symptomatic treatment was decided, after which the patient died.
