Successful surgical resection of solitary plasmacytoma of the liver mimicking hepatocellular carcinoma. A case report

Main Article Content

Mariateresa Mirarchi
Emilio De Raffele
Francesco Bacci
Dajana Cuicchi
Ferdinando Lecce
Bruno Cola

Abstract

Solitary extramedullary plasmacitomas (SEMP) of the liver are very rare. We report the case of an elderly woman with a huge symptomatic SEMP of the liver mimicking hepatocellular carcinoma (HCC). The patient was a 89-year-old woman who presented with severe abdominal pain and a huge solid mass in the right hypochondrium. The laboratory data on admission revealed normal liver function tests. A multiphasic computed tomography (CT) showed a huge solid mass of the left hemiliver, hypoattenuating on noncontrast images, dishomogeneously hyperenhancing in the late arterial phase, with washout in the portal venous and equilibrium phases. A 18F-FDG positron emission tomography (18F-FDG PET)-CT scan documented a marked FDG uptake within the lesion, without evidence of extrahepatic metastases. We considered the clinical and radiologic findings consistent with the diagnosis of high-grade HCC with areas of intratumoral necrosis preluding to possible tumour rupture.


Surgical resection was ultimately considered feasible with a reasonable risk and the patient underwent left hepatectomy with diaphragmatic resection. Pathological examination exhibited an extramedullary plasmacytoma. At immunohistochemical analysis neoplastic cells were positive for CD45, CD38, IRF4, HTPD52, kappa-chain, but negative for lambda-chain; Mib-1 proliferation index was 50%. Subsequent clinical evaluation excluded any sign of multiple myeloma, so that a diagnosis of truly localized SEMP of the liver was finally established.


To our knowledge, this is the first case of a solitary extramedullary plasmacitoma of the liver undergoing successful radical liver resection. The patient is alive and well 5 years after surgery without evidence of local recurrence and of systemic disease.

Article Details

How to Cite
Mirarchi, Mariateresa, et al. “Successful Surgical Resection of Solitary Plasmacytoma of the Liver Mimicking Hepatocellular Carcinoma. A Case Report”. Annali Italiani Di Chirurgia, vol. 87, no. 4, July 2016, pp. 343-9, https://annaliitalianidichirurgia.it/index.php/aic/article/view/1775.
Section
Case Report