Published online May 14, 2019. doi: 10.3748/wjg.v25.i18.2264
Peer-review started: March 6, 2019
First decision: April 5, 2019
Revised: April 17, 2019
Accepted: April 19, 2019
Article in press: April 20, 2019
Published online: May 14, 2019
Polycystic liver disease (PCLD) with a large cystic volume deteriorates the quality of life of patients through substantial effects on the adjacent organs, recurrent cyst infections, cyst rupture, and hemorrhage. Surgical or radiological intervention is usually needed to alleviate these symptoms. We report a rare case of the cystic metastasis of renal cell carcinoma (RCC), which was misdiagnosed as PCLD, as a result of the clinical and radiological similarity between these disorders.
A 74-year-old female who had undergone nephrectomy for papillary-type RCC (PRCC) was suffering from abdominal pain and the recurrent intracystic hemorrhage of multiple cysts in the liver. Imaging studies and aspiration cytology of the cysts showed no evidence of malignancy. With a diagnosis of autosomal dominant polycystic liver disease, the patient received hepatectomy for the purpose of mass reduction and infectious cyst removal. Surgery was performed without complications, and the patient was discharged on postoperative day 14. Postoperatively, the pathology revealed a diagnosis of recurrent PRCC with cystic formation.
This case demonstrates the importance of excluding the cystic metastasis of a cancer when liver cysts are observed.
Core tip: Polycystic liver disease (PCLD) usually exhibits typical presentations in imaging studies, but the diagnosis is sometimes challenging because of the late onset of this genetic disorder and the atypical presentations of other diseases. In a case of cystic metastasis of renal cell carcinoma, the disease could be misdiagnosed as PCLD due to the clinical and radiological similarity between these disorders. This case demonstrates that when multiple cystic lesions are observed in the liver, it is important to first exclude the cystic metastasis of a cancer. Additionally, some specific types of cancer can have different presentations at metastasis and recurrence.