title: Multifocal hepatic cystic mass as first manifestation of metastatic spinal hemangiopericytoma.
abstract: BACKGROUND
  Hemangiopericytomas (HPCs) are rare vascular tumors with a high malignant potential. Hepatic metastases from HPC are very infrequent and usually show a distinctive solid aspect with a surrounding pseudocapsule.
  
  
  METHODS
  A 37-year-old man with a previous medical history of recurrent spinal hemangiopericytoma with a 9cm×7cm cystic hepatic mass detected on follow-up. Contrast enhanced US and MRI confirmed the presence the lesion showing mixed (solid and cystic) content. Parasitic and viral serology plus serum tumoral markers (CEA, ca 19.9, ca 125, AFP) tests, upper and lower endoscopy and general laboratory tests were normal and extended left lobectomy was performed. Histopathologic study confirmed the diagnosis of multifocal metastasic hemangiopericytoma with moderate CD-34, CD-99 and Bcl-2 positivity after immunohistochemical staining. After 1-year follow-up the patient does not present any evidence of abdominal recurrence but a skull base recurrence has been detected.
  
  
  CONCLUSIONS
  Liver metastasis from spinal HPC are uncommon and do not have cystic appearance so radiologic diagnosis can be challenging. In spite of the presence of previously diagnosed HPC context, the presence of a liver cystic mass in a young patient makes necessary to discard a number much more frequent benign and malignant diagnosis before metastatic disease can be confirmed.
  
  
  CONCLUSIONS
  The presence of a cystic hepatic mass makes it mandatory to rule out a number neoplasms other than metastasic HPC before a definitive diagnosis is made. In addition to local radiotherapy and antiangiogenic agents, surgery can be useful to treat liver dissemination.
authors.affiliation: Department of General and Digestive Surgery, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona (Barcelona), Spain. Electronic address: balibrea@gmail.com.
authors.forename: José M
authors.initials: JM
authors.lastname: Balibrea
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira-Argelagués
authors.forename: Ana M
authors.initials: AM
authors.lastname: Otero-Piñeiro
authors.forename: Juan F
authors.initials: JF
authors.lastname: Julián
authors.forename: Cristina
authors.initials: C
authors.lastname: Carrato
authors.forename: Jordi
authors.initials: J
authors.lastname: Navinés
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Sánchez
authors.forename: Jaime
authors.initials: J
authors.lastname: Fernández-Llamazares