A 23-year-old woman was studied for epigastric pain episodes of 4 or 5 months of evolution, with no relation to intake, which improved after emesis.
Relevant personal history included the use of oral contraceptives for 3 years.
Blood tests showed leukocytes in 3.570 x 109/l, Hb 115 g/l with MCV of 78.
Rest within normal limits.
Between episodes is asymptomatic with normal bowel habit without pathological products.
A plain abdominal X-ray showed heterogeneous images of calcium density of 4-5 cm projected over hepatic flexure of the colon.
Abdominal ultrasound objectifies biliary mud and adjacent to the gallbladder an image of 45 mm, heterogeneous with hyperechogenic areas compatible with the diagnosis of hydatid cyst.
Despite reporting continuous contact with dogs in an endemic area of hydatid disease such as Spain (1.2), and initially guiding the diagnosis to this disease, serology for hydatid disease is negative.
Abdominal CT showed hepatomegaly with partially calcified LOE in segment V of 50 mm and rounded morphology with lobulated edges and rounded images of smaller size in the periphery.
The image is compatible with hydatid cyst without ruling out in its differential diagnosis the possibility of partially calcified hemangioma.
The image of the gallbladder is numerous microlithiasis without inflammatory signs.
The CT also showed a 31 mm hemangioma in segment IV and cortical cysts in both kidneys.
Cholecystectomy plus cystopericystectomy with presumptive diagnosis of hydatid cyst plus lithiasis was performed.
A right subcostal laparotomy was performed.
Gallbladder vesicle was observed with an intravesicular tumor of pterygium consistency total not corresponding to hepatic mass, without LOE in V. Median intraoperative biopsy of the mass diagnosed as simple angiomyoma including cholecystectomy performed.
Postoperative period was uneventful.
The subsequent anatomopathological study describes a solid mass of elastic consistency and expansive growth that respects cystic mucosa and serosa.
Histology and immunohistochemical study confirmed the diagnosis of leiomyomatosis and intramural effusion with dystrophic calcifications and ossification within the liver.
The sample was negative for EBV and C-Kit / CD-117.
Currently, the patient is asymptomatic, after abdominal ultrasound shows no recurrence of the disease or other changes 15 months later.
