P2895 - Hepatic Leiomyoma in an Asymptomatic Middle-Aged Woman

Eugene C. Nwankwo, MD, MS¹, Samuel Burton, MD², Kamran Qureshi, MD^1
1St. Louis University School of Medicine, St. Louis, MO; ²St. Louis University, St. Louis, MO

Introduction: Primary hepatic leiomyomas (PHL) are neoplasms originating from benign smooth muscle proliferation mostly found in the genitourinary tract of women in their reproductive age but may exist in any organ containing smooth muscle.1,2 There is limited knowledge of these tumors due to low prevalence. We present a case of a 52-year-old female who was incidentally found benign hepatic leiomyoma proven by biopsy.

Case Description/Methods: 52-year-old female with prior acute HBV infection (with spontaneous resolution) was referred to our clinic for evaluation of incidental 3.9 x 5.4 x 4.6 cm lesion in the right hepatic lobe on abdominal ultrasound. The patient had recently established with a new primary care provider. Ultrasound was obtained after a positive HBcAb during routine labs. Patient was asymptomatic and denies nausea, vomiting, abdominal pain, change in appetite or weight. Family history was negative for Inflammatory Bowel Disease colorectal or liver cancers. Routine labs were unremarkable. Hepatitis serologies were repeated with positive antibodies for HBs, HBc, and HBe. She was negative for HCV antibodies, or markers of active HBV infection. Tumor markers CA-19, CA-125, CEA, AFP were negative.
Multi-phase CT showed a fusiform mass along the capsule of the liver anterior to hepatic segments 8/4a with mild arterial enhancement and progressive delayed enhancement (Figure 1). Image guided three-core biopsy showed low grade spindle cell neoplasm with myogenic differentiation (favoring leiomyoma). Immunohistochemistry showed the spindle cells to be positive for smooth muscle actin, negative for S100, and negative for CD117. Such combination of staining is diagnostic of leiomyoma. Given the asymptomatic and benign nature, patient has been followed with yearly CT imaging without significant increase in size or development of symptoms.


Discussion: There are few cases of PHL in literature. In many cases, patients present with symptoms related to mass effect including abdominal pain and obstructive jaundice especially in adult women.4 Occasionally such as in our case, PHL can be discovered incidentally with no symptoms reported. Although rare, PHL should be considered in differentials for solid lesion of the liver. Confirmation of diagnosis is accomplished by tissue staining and immunohistochemistry for smooth muscle antibody. Whenever a diagnosis of PHL is suspected or established, imaging (CT, MRI) should be performed to evaluate the rest of the abdomen and pelvis for other leiomyomas.



Disclosures:


Eugene C. Nwankwo, MD, MS¹, Samuel Burton, MD², Kamran Qureshi, MD¹. P2895 - Hepatic Leiomyoma in an Asymptomatic Middle-Aged Woman, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.