Primary squamous cell carcinoma of the liver. Surprising findings in dysontogenetic liver cysts

HISTORY AND CLINICAL FINDINGS: A 60-year-old woman presented with intermittent fever and pain in the right upper abdomen. The patient had spent the last 30 years in the Middle East and Africa. EXAMINATION: Multiple hepatic lesions with cystic parts were demonstrated sonographically. Ecchinococcosis as well as amoebiasis had been excluded. Laboratory findings showed elevated levels of inflammatory parameters, lactate dehydrogenase (4107 U/l), squamous cell carcinoma antigen and CA -125. The liver enzymes were found to be within the normal range. DIAGNOSIS: A squamous cell carcinoma was detected by liver biopsy. The search for a possible primary site elsewhere in the body yielded negative results, so that the tumor must be regarded as primary in the liver. THERAPY: Because of the diffuse tumour growth surgical resection was impossible. The patient underwent chemotherapy. She died 9 month after the squamous cell carcinoma had been diagnosed. CONCLUSION: This case report and a medline research indicate that hepatic neoplasms sometimes must be suspected in patients with liver cysts.