TY - JOUR T1 - Unique diagnostic challenge in surgery: hepatic abscess versus malignancy JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2022-250489 VL - 15 IS - 9 SP - e250489 AU - Shrenik Govindaraj AU - Clement Prakash AU - Anuradha Ananthamurthy AU - Sridar Govindaraj Y1 - 2022/09/01 UR - http://casereports.bmj.com/content/15/9/e250489.abstract N2 - 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. ER -