A Case of Hepatic Tuberculoma with Gastric Cancer

Kazushige Ichinohe, Hitoshi Kawasaki, Setsuo Akaishi, Takashi Nishi, Yutaka Umehara and Mutsuo Sasaki

Second Department of Surgery, Hirosaki University School of Medicine

An unusual case of hepatic tuberculoma misdiagnosed as a metastasis of advanced gastric cancer is reported. A 78-year-old woman was admitted to our University Hospital with tuberculosis of the skin. An advanced gastric cancer and hepatic tumor were detected by gastrointestinal examinations and imaging studies. Computed tomography revealed a hypodense hepatic mass without calcification. Magnetic resonance imaging (MRI) showed a hypointense mass in the liver on T1-weighted spin echo images and a hyperintense area on T2-weighted spin echo images. Contrast-enhanced dynamic MRI visualized the liver mass as a rim-enhanced area. A diagnosis of liver metastasis from gastric cancer was made, and distal gastrectomy and partial resection of the liver were performed. After the operation, a definitive diagnosis of hepatic tuberculoma was made based on histopathological studies that revealed both epitheloid cells and Langhans giant cells with caseous necrosis in the liver specimen. Although several cases of hepatic tuberculoma have been reported, the typical imaging findings of this tumor have never been described making it difficult to distinguish hepatic tuberculoma from the other primary or secondary liver tumors without liver biopsy. In our case, the liver tumor was misdiagnosed as a metastasis from gastric cancer, and palliative surgery was performed. Because preoperative liver biopsy is unusual cases of hepatic tumor and cancer, the definitive diagnosis of hepatic tuberculoma required intraoperative biopsy.

Key words
gastric cancer, hepatic tuberculoma, magnetic resonance imaging

Reprint requests
Kazushige Ichinohe Second Department of Surgery, Hirosaki University School of Medicine 5 Zaifu-cho, Hirosaki, 036-8562 JAPAN

Accepted
September 20, 2000

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