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Unique diagnostic challenge in surgery: hepatic abscess versus malignancy
  1. Shrenik Govindaraj1,
  2. Clement Prakash1,
  3. Anuradha Ananthamurthy2 and
  4. Sridar Govindaraj3
  1. 1Department of General Surgery and Laparoscopy, St John's Medical College Hospital, Bangalore, Karnataka, India
  2. 2Department of Pathology, St John's Medical College Hospital, Bangalore, Karnataka, India
  3. 3Department of General Surgery and Laparoscopy, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
  1. Correspondence to Professor Sridar Govindaraj; sridar_sasi{at}yahoo.com

Abstract

A man in his 30s had presented with a history of abdominal pain, vomiting and high-grade fever. He had tender hepatomegaly with peritonism in the upper abdomen. Investigations revealed a neutrophilic leucocytosis, and contrast-enhanced CT had shown several well-defined peripherally enhancing thick-walled cystic lesions with non-enhancing centres throughout the liver suggestive of pyogenic liver abscess, treated initially with antibiotics. However, ultrasonography-guided fine needle aspiration revealed atypical neoplastic cells, and a trucut biopsy showed squamous cell carcinoma (SCC). He developed acute shortness of breath. CT pulmonary angiogram confirmed pulmonary thromboembolism (PTE). Incidentally, here we saw a solitary nodule in the right middle lobe, probably a neoplastic lesion. His condition deteriorated rapidly secondary to PTE and died. A pathological review was positive for CK7, p40, p63 and CK19 confirming SCC. We concluded the primary was a pulmonary SCC with multiple hepatic metastases. Hepatic metastases can mimic an abscess; trucut biopsy with immunohistochemistry was critical for a definitive diagnosis.

  • Gastroenterology
  • Hepatic cancer
  • Pathology
  • Interventional radiology

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Footnotes

  • Contributors All authors have contributed responsibility in this case report. SG: data acquisition, interpretation and analysis, drafting of the article, final drafting and approval of the manuscript. CP: critical review for intellectual content, final drafting and approval of the manuscript. AA: the pathology slides were provided by her and a critical review of the manuscript. Sridar Govindaraj: article design, critical review for intellectual content, final drafting and approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.