SOLID PAPILLARY TUMOR AS PRIMITIVE LESION OF THE LIVER. CASE REPORT

Introduction: Solid papillary tumor (SPT) is an uncommon lesion of the pancreas, which origin and behavior are poorly understood. Rare cases of SPT have been described in extrapancreatic sites and only one has been described in the liver. Here we describe a case of a primitive SPT arising in the liver. Methods: A 56-year-old Ukrainian woman came to the clinical attention for cholestasis with a bulky hepatic mass. A MR-cholangio-pancreatography revealed a polilobated mass measuring 20 cm, occupying the right liver (segments S4, S5, S6, S7 and S8), with inhomogeneous contrastenhancement due to hemorrhagic and fi brous areas. These features were deemed compatible with an angiomatous lesion. Neoplastic markers were within normal limits. Tests for HBV and HCV were negative. The patient underwent a percutaneous needle biopsy and needle aspiration of the lesion. As the morphology suggested an epithelial lesion, but all epithelial markers were negative, a diagnosis of poorly differentiated epitheliomorphic neoplasia or epithelioid sarcoma was suggested. Results: The patient underwent a right hepatectomy enlarged to the IV segment. Histology revealed an epitheliomorphic tumor formed by medium-size cells, with round and mildly atypical nuclei, granular chromatin, small nucleoli and rare mitosis. Vascular invasion by neoplastic emboli was observed. Immunohistochemically, the neoplastic cells were positive for vimentin, α1-antytrypsin, α1-antychymotrypsin, progesteron receptor, beta-catenin and NSE (neuron-specifi c-enolase). Histological, immunohistochemical and ultrastructural features were coherent with the diagnosis of solid papillary tumor. Since the patient showed no other oncologically signifi cative lesions, the primitivity of this tumor could be confi rmed. No evidence of disease has been reported at one year follow-up. Conclusion: Most SPTs are described as primitive lesions of the pancreas. Rare cases have been reported in extrapancreatic sites, including omentum, peritoneum and mesocolon. Only one case has been described in the liver as a primary tumor, a possible site of metastatic spread in the rare aggressive forms. In our patient, both imaging and surgical exploration excluded other tumors outside the liver, making the present case, at best of our evaluation, the second case described so far in literature of primary SPT of the liver.