Primary Liver Cancer Presenting As Pyogenic Liver Abscess: Characteristics, Diagnosis, and Management.

Background and Objectives Primary liver cancer (PLC) presenting as pyogenic liver abscess (PLA) is potentially life-threatening, but has been occasionally reported, especially for cholangiocarcinoma.Methods: Medical records of nine patients who presented as PLA, but were eventually confirmed as hepatocellular carcinoma (HCC; n = 5) or intrahepatic cholangiocarcinoma (IHCC; n 4), from September 1997 through April 2011, were retrospectively reviewed.Results: Presenting symptoms included fever, chills, right-upper-quadrant abdominal pain, nausea, vomiting, weight loss, and diarrhea. Physical signs included tenderness in the right-upper-quadrant abdomen, jaundice, and ascites. With the exception of elevated alpha-fetoprotein (AFP) in HCC patients and elevated carbohydrate antigen 19-9 (CA19-9) in IHCC patients, lab results were not significantly different between these nine patients and PLA patients. All the nine patients underwent invasive treatment in addition to antibiotics.Conclusions: Elevated AFP and CA19-9 could suggest HCC and IHCC in patients with symptoms/signs typical of PLA. Contrast-enhanced computed tomography could be helpful in patients with normal AFP and CA19-9. Making an accurate and early diagnosis and seizing the opportunity of surgery are essential to improve the management strategies of patients with PLC mimicking PLA. J. Surg. Oncol. 2012; 105: 687-691. (C) 2011 Wiley Periodicals, Inc.