KHI TỔN THƯƠNG DẠNG NANG KHÔNG PHẢI LÀ NANG: SARCOMA PHÔI KHÔNG BIỆT HÓA CỦA GAN

Abstract

Undifferentiated Embryonal Sarcoma of the Liver (UESL) is a rare malignant mesenchymal tumor that predominantly occurs in children and is exceedingly uncommon in adults. Due to its nonspecific clinical, radiologic, and histopathologic features, UESL is frequently misdiagnosed as a benign lesion or other hepatic neoplasms, potentially resulting in delayed treatment. We report the case of a 33-year-old woman who presented with persistent abdominal pain. Ultrasonography and magnetic resonance imaging revealed a large cystic hepatic lesion, which was initially diagnosed as a liver fluke–related lesion. The patient was treated with antiparasitic therapy for one month in combination with percutaneous drainage of the hepatic cyst. However, follow-up imaging demonstrated minimal interval change in the lesion. The patient subsequently underwent central hepatectomy. Initial postoperative histopathological evaluation suggested synovial sarcoma. Following surgery, the patient did not receive adjuvant therapy and instead self-administered traditional herbal medicine at home. Five months later, she was readmitted with severe abdominal pain and dyspnea. Imaging studies demonstrated recurrent hepatic disease with peritoneal metastases. Multidisciplinary tumor board consultation recommended additional immunohistochemical analysis of the previous surgical specimen, which ultimately confirmed the diagnosis of UESL. This case highlights the importance of considering UESL in the differential diagnosis of atypical hepatic lesions, particularly when lesions fail to respond to conventional treatment, and underscores the essential role of a multidisciplinary approach in the diagnosis and management of UESL.