A 79-year-old woman with a history of left nephrectomy for tuberculosis and a lesion diagnosed as cystic in segment V of the liver by computed tomography (CT) control 5 years earlier.
She presented with a mass sensation and discomfort in the upper right abdominal quadrant.
Physical examination revealed occupation of the right hypochondrium due to a large mass with local discomfort.
Blood tests showed only a slight elevation in alkaline phosphatase determination.
Contrast-enhanced abdominal CT showed a large liver mass of 15.8 x 11.4 cm, solid aspect, very heterogeneous, with significant and irregular uptake of contrast, occupying segments IV, V, VI and VIII colonic structures.
Ultrasound with percutaneous core needle biopsy of the lesion is performed to guide the diagnosis.
Histopathology shows mesenchymal proliferation with low atypia, a proliferative index assessed by immunohistochemical study of Ki67 less than 1%, immunohistochemical positivity for vimentin, CD34 and bcl-2 AE, and
With a diagnostic orientation of hepatic SFT and a negative extension study, surgical resection of the lesion is indicated.
Since an insufficient volume of the future liver remnant is estimated, right portal embolization is performed before surgical resection.
The volume of the future liver remnant 4 weeks after embolization is 31%.
The day before surgery selective arterial embolization of the tumor branch dependent on the right hepatic artery was performed in order to minimize possible intraoperative bleeding.
Right hepatectomy was performed extended to segment IV with inclusion of the middle suprahepatic vein, without requiring Pringle maneuver and without intraoperative incidents.
The patient had a good postoperative course and was discharged on the sixth day.
The final pathological anatomy of the specimen reports a well-defined 18 cm maximum diameter tumor, consisting of lobulated tissue with areas of homogeneous aspect and other areas of fasciculate or myxoid appearance, white or grayish.
It concludes that it is a SFT of expansive margins, with hypercellular areas in approximately 5%, with mild to moderate atypia and occasional mitotic figures (< 1 mitosis/10 high-power fields).
The mean proliferative index Ki67 is 12% in hypercellular areas.
Surgical resection margins are free of injury.
Focal changes in the tumor and adjacent parenchyma attributable to embolization are also evident.
At present and after a follow-up period of 2 years and 7 months, the patient is free of disease.
