Liver metastasis mimicking a liver cyst of a thymoma in a 38-year-old immunocompromised patient

Abstract

Cystic liver lesions (CLL) are common and, in the majority of cases, benign. However, the range of differential diagnoses of CLL is wide. A combination of medical history, blood test results, and imaging can help find the correct diagnosis. We report the case of a 38-year-old immunocompromised female patient with a history of thymectomy and postoperative radiation 3 years prior due to thymoma. Subsequently, the patient was referred to our department for clarification of a cystic liver lesion. During short-term follow-up, the lesion increased in size, and due to the contrast agent behavior in the ultrasound and MRI examination, the suspicion of a biliary cystadenocarcinoma was considered.

Furthermore, imaging showed several subcentimetric liver lesions of unknown dignity. Finally, pericystectomy and atypical partial liver resection was performed. Histology revealed a cystic metastasis of the malignant B3 thymoma and a cavernous hemangioma. Liver metastases of a thymoma are rare, and this is the first case of a cystic liver metastasis of a thymoma. The presented case illustrates that in the management of CLLs beside imaging techniques, the medical history with previous conditions should be considered, especially in past malignancies.

Zusammenfassung

Zystische Leberläsionen sind häufig und in der Mehrzahl der Fälle gutartig. Das differenzialdiagnostische Spektrum ist jedoch breit. Die Kombination von Anamnese, Blutuntersuchungen und bildgebender Verfahren ist hilfreich, um die richtige Diagnose zu stellen. Wir berichten den Fall einer 38-jährigen immunsupprimierten Patientin mit Zustand nach Thymektomie und postoperativer Bestrahlung vor 3 Jahren aufgrund eines Thymoms. Anschließend wurde die Patientin zur Abklärung einer zystischen Leberläsion in unsere Klinik überwiesen. Im kurzfristigen Intervall nahm die Läsion an Größe zu und es wurde aufgrund des Kontrastmittelverhaltens in der Ultraschall- und MRT-Untersuchung der Verdacht auf ein biliäres Zystadenokarzinom gestellt. Darüber hinaus zeigte die Bildgebung mehrere sehr kleine Leberläsionen unbekannter Dignität. Schließlich wurden eine Perizystektomie und eine atypische Leberteilresektion durchgeführt. Die histologische Untersuchung ergab eine zystische Metastase des malignen B3-Thymoms und ein kavernöses Hämangiom. Lebermetastasen eines Thymoms sind selten. Dies ist der erste Fall einer zystischen Lebermetastase eines Thymoms. Der vorgestellte Fall verdeutlicht, dass beim Management zystischer Leberläsionen neben bildgebenden Verfahren die Anamnese mit Vorerkrankungen, insbesondere bei zurückliegenden Malignomen, berücksichtigt werden sollte.

Schlüsselwörter

Zystische Leberläsion - Zyste - Biliäres Zystadenokarzinom - Thymom - Lebermetastasen

Keywords

cystic liver lesion - cyst - biliary cystadenoma - thymoma - liver metastasis

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