Case of the month May 2025: Primary or secondary liver lesion – the lifelong question
Case of the month April 2025: Palpable mass
April 1, 2025
Evelina Atanasova 1, Christo Pentchev¹, Dimitar Popov¹ and Christian Nolsøe²
1 Clinic of Gastroenterology, University Hospital „St. Ivan Rilski” Sofia, Bulgaria; e-mail: eva_gatanasova@abv.bg; ch.pentchev@gmail.com, dr_popov@yahoo.com
2 Centre for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, Køge, Denmark; cnolsoe@cnolsoe.dk
* Correspondence: eva_gatanasova@abv.bg; ch.pentchev@gmail.com
Clinical history
An 81-year-old female with lower GI-tract symptoms, anaemia and weight loss was refered to our department. She had a previous history of non-specific inflamation in the sigmoid colon and rectum and surgery for grade 1 squamous cell carcinoma in the maxilary region, and another- hysterectomy for uterine prolapse. She had a family history of colorectal carcinoma and her son had died from pancreatic cancer. Laboratory results showed iron-deficiency anaemia, elevated CA 19-9 (2 times the upper limit of normal), slightly elevated AFP, moderately elevated liver enzymes, presence of an ocult HBV infection (anti-HDV – negative, undetectable HBV DNA). An abdominal ultrasound revealed an enlarged non-cirrhotic liver with multiple lesions up to 9 cm in size. A colonoscopy and a gastroscopy were performed, both were negative.
Images
Video 1: CEUS of the lesion previously shown – arterial phase. Note the rapid and homogenous arterial hyperenhancement.
Video 2: CEUS of the same lesion – portalvenous phase. Note the relatively early but mild ‘wash-out’. The lesion is definitely malignant, but without typical signs for HCC. The liver is not cirrhotic.