title: Primary liver cancer presenting as pyogenic liver abscess: characteristics, diagnosis, and management.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Li
authors.forename: Guangbing
authors.initials: G
authors.lastname: Li
authors.forename: Ruoyu
authors.initials: R
authors.lastname: Miao
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.forename: Shouxian
authors.initials: S
authors.lastname: Zhong
authors.forename: Xinting
authors.initials: X
authors.lastname: Sang
authors.forename: Yilei
authors.initials: Y
authors.lastname: Mao
authors.forename: Haitao
authors.initials: H
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D018395:CA-19-9 Antigen / Q000097:blood; D005260:Female; D006801:Humans; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D018395:CA-19-9 Antigen; D000509:alpha-Fetoproteins