Multicystic hepatocarcinoma mimicking liver abscess

Common pitfalls and diagnostic challenges in the application of LI-RADS CT/MRI algorithms: a comprehensive review

The Liver Imaging Reporting and Data System (LI-RADS) was developed to standardize the interpretation and reporting of liver observations in at-risk populations, aiding in the diagnosis of hepatocellular carcinoma (HCC). Despite its advantages, the application of LI-RADS can be challenging due to the complexity of liver pathology and imaging interpretation. This comprehensive review highlights common pitfalls encountered in LI-RADS application and offers practical strategies to enhance diagnostic accuracy and consistency among radiologists. Key areas of difficulty include misapplication in non-high-risk populations, misinterpretation of major imaging features such as arterial phase hyperenhancement and washout, and incorrect application of ancillary features. Additionally, the review addresses challenges related to atypical HCC presentations and HCC mimics. By recognizing and addressing these pitfalls, radiologists can improve diagnostic accuracy and avoid common mistakes in the diagnosis of HCC.

Giant cystic hepatocarcinoma in the absence of cirrhosis

The diagnosis of hepatocellular carcinoma (HCC) became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Several mechanisms for the cystic changes of HCC have been suggested, including arterial thrombosis, inflammation, and rapid tumor growth. This paper reports an uncommon case of a 74-year-old patient, who presented with pain in the upper right abdomen and large cystic mass involving right lobe of the liver. He was diagnosed as cystic HCC, in the absence of cirrhosis, after surgery.

Case report of hepatic pseudocyst: A rare manifestation of liver metastasis from an anal squamous cell carcinoma

INTRODUCTION

Liver metastasis of an anal squamous cell carcinoma (SCC) with a pseudocyst is uncommon. There are many diseases which form hepatic cystic lesions and sometimes it is difficult to arrive at an accurate diagnosis.

PRESENTATION OF CASE

A 69-year-old woman visited our hospital with complaints of bloody stool and difficult defecation. A palpable mass in the anal canal was found on digital examination. The laboratory tests revealed anemia and raised levels of SCC antigen. On endoscopy a type 2 tumor was identified in the anal canal and biopsy revealed SCC. The patient was diagnosed with advanced anal SCC (cT2N1aM0, cStage IIIA) as a result of the examination and underwent chemoradiotherapy (CRT); unfortunately the tumor persisted after CRT. A salvage abdominoperineal resection with D2 and left lateral lymph node dissection was conducted. Histopathologically, the tumor was diagnosed as poorly differentiated SCC. She was readmitted for fever 3 weeks after surgery, and the abdominal CT showed multiple low density areas with enhancement at the edge of the liver, suggesting abscess or metastasis. The metastatic SCC was revealed by cytology of liver drainage and liver biopsy.

DISCUSSION

Anal cancers are sometimes encountered however; a pseudo cystic presentation of a liver metastasis is very rare which makes it difficult to distinguish from other diseases.

CONCLUSION

We present a case of SCC in the anal canal with liver metastasis presenting as a hepatic pseudocyst.