Metastatic Liver Disease – Presenting as Multiple Hepatic Cysts
A 59 year-old woman with a history of successfully treated Hepatitis-C, Systemic Lupus Erythematosus, and a remote history of melanoma of the scalp presented to our center for
evaluation of abdominal pain, nausea, vomiting, and malaise. An outpatient CT scan revealed
numerous cystic liver lesions. A liver ultrasound from one year prior to admission showed a
mildly heterogeneous and echogenic liver texture with no observed masses or dilated ducts.
Her genotype 1b Hepatitis-C virus had been successfully treated with Pegylated interferon,
Ribavirin, and Telaprevir 9 months prior to presentation. A liver biopsy revealed stage I fibrosis
6 months prior to presentation.
At our center, an abdominal MRI revealed greater than 50 hepatic cysts and cystic
masses. A dominant 6 cm cystic mass in segment 2 was notable for peripheral enhancement and
evidence of intralesional hemorrhage. A 2 cm complex appearing cystic mass was also noted at
the junction of segments 6 and 7. No as cites or splenomegaly was observed (Figure 1). Further
work-up with an EGD and liver FNA were performed. The EGD revealed an 8 mm ulcer in the
gastric fundus (Figure 2) as well as multiple small nodules in the gastric body. Biopsies of the
gastric ulcer and nodules were consistent with malignant melanoma.
Liver Res Open J. 2015; 1(1): 11-13. doi: 10.17140/LROJ-1-102