Main Article Content


Primary hepatic leiomyosarcoma (PHL) is a very rare primary liver tumour. These tumours usually arise from intrahepatic vascular structures, gallbladder, or ligamentum teres. The pathogenesis of this disease is still unknown. We report a 53-year-old man with complaints of intermittent right upper abdominal pain for one month, decreased appetite, nausea, weight loss, and tea-coloured urination. The patient denied any complaints of defecation pattern. On physical examination, jaundice was present in both eyes and the whole-body skin, tenderness in the right hypochondriacal region, and enlarged liver with a lumpy surface. The laboratory examination demonstrated increased transaminase enzymes and bilirubin, while hepatitis B and C were negative. The patient underwent several tests for tumour markers, such as CA 19-9 50 (<37 U/mL), AFP 1.23 (<5.81 IU/mL), and CEA 0.83 (<3 ng/mL). Ultrasound demonstrated an enlarged liver, multiple liver nodules, and cholelithiasis. Meanwhile, the abdomen’s computerised tomography (CT) scan shows a solid heterogeneity image with an irregular border in segments 1 and 4b and a tumoral thrombus in the inferior vena cava. The diagnosis was confirmed by biopsy and immunohistochemistry (IHC); vimentin and smooth muscle actin (SMA) results were positive, while CD 34, CD 117, and cytokeratin were negative. Our patient was diagnosed with PHL stage IVa (T4N2M0). PHL is a particularly rare tumour with a poor prognosis. The patient died after one month of diagnosis. Diagnosis of PHL is challenging. It was based on clinical features, physical examinations, laboratory examinations, and other supporting investigations.


Primer Leiomyosarcoma Liver

Article Details

Author Biography

Rahmat Nugroho, Department of Internal Medicine, Faculty of Medicine, Universitas Sebelas Maret, Dr. Moewardi General Hospital, Surakarta, Indonesia

Divisi Gastroenterohepatologi Ilmu Penyakit Dalam RSDM-FK UNS

How to Cite
Pramana, T. Y., Kusnanto, P. ., Darmayani, A. ., Prasetyo, D. ., Nugroho, R., Wasita, B. ., & Widiastuti. (2022). A rare primary liver tumour case report: 53-year-old man with primary hepatic leiomyosarcoma. JKKI : Jurnal Kedokteran Dan Kesehatan Indonesia, 13(3), 321–324.


  1. Bedossa P, Paradis V. Blumgart’s Surgery of the Liver, Billiary Tract and Pancreas: Tumors of the Liver. 7th ed. 2017. 1272–1298 p.
  2. Maeda T, Yugawa K, Kinjo N, Imai D, Sanefuji K, Kawata K, et al. Large surgically resected leiomyosarcoma of the liver: a case report. Surg Case Reports. 2020;6(1):1–5.
  3. Shivathirthan N, Kita J, Iso Y, Hachiya H, KyungHwa P, Sawada T, et al. Primary hepatic leiomyosarcoma: case report and literature review. World J Gastrointest Oncol. 2011;3(10):148.
  4. Vagholkar K. Obstructive jaundice: understanding the pathophysiology. Int J Surg Med. 2020;6:26–31.
  5. PERKENI. Panduan Pengelolaan Dislipidemia di Indonesia. Jakarta: Perkeni; 2019.
  6. Batajoo H, Hazra NK. Analysis of serum lipid profile in cholelithiasis patients. J Nepal Health Res Counc. 2013;
  7. Grigor’eva IN, Maliutina SK, Voevoda MI. Role of hyperlipidemia in cholelithiasis. Eksp i Klin Gastroenterol Exp Clin Gastroenterol. 2010;(4):64–8.
  8. Permana T. Hubungan Dislipidemia dengan Kejadian Kolelitiasis di RSUP Dr. M. Djamil Padang Periode 2010-2014. Universitas Andalas; 2016.
  9. Abraham S, Rivero HG, Erlikh I V, Griffith LF, Kondamudi VK. Surgical and nonsurgical management of gallstones. Am Fam Physician. 2014;89(10):795–802.
  10. Tazuma S, Unno M, Igarashi Y, Inui K, Uchiyama K, Kai M, et al. Evidence-based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol. 2017;52(3):276–300.
  11. More R, Shera I, Patel S, Setya A, Raj V. Primary Hepatic Leiomyosarcoma A Space Occupying Lesion in the Liver: An Enigma for Diagnosis. Gastroenterol Pancreatol Liver Disord. 2017;4(5):1–3.
  12. Mitra S, Rathi S, Debi U, Dhiman RK, Das A. Primary hepatic leiomyosarcoma: histopathologist’s perspective of a rare case. J Clin Exp Hepatol. 2018;8(3):321–6.
  13. Vella S, Cortis K, Pisani D, Pocock J, Aldrighetti L. Case of primary hepatic leiomyosarcoma successfully treated with laparoscopic right hepatectomy. BMJ Case Reports CP. 2020;13(2).
  14. Esposito F, Lim C, Baranes L, Salloum C, Feray C, Calderaro J, et al. Primary leiomyosarcoma of the liver: Two new cases and a systematic review. Ann hepato-biliary-pancreatic Surg. 2020;24(1):63.
  15. Mehta V, Rajawat M, Rastogi S, Phulware RH, Mezencev R. Leiomyosarcoma of the stomach with metastasis to the liver: a case report with review of the literature. Futur Sci OA. 2017;4(2):FSO264.
  16. Takehara K, Aoki H, Takehara Y, Yamasaki R, Tanakaya K, Takeuchi H. Primary hepatic leiomyosarcoma with liver metastasis of rectal cancer. World J Gastroenterol WJG. 2012;18(38):5479.
  17. Lin Y-H, Lin C-C, Concejero AM, Yong C-C, Kuo F-Y, Wang C-C. Surgical experience of adult primary hepatic sarcomas. World J Surg Oncol. 2015;13(1):1–6.
  18. Lv W, Han J, Cheng D, Tang W, Lu D. Imaging features of primary hepatic leiomyosarcoma: a case report and review of literature. Oncol Lett. 2015;9(5):2256–60.
  19. Zhu KL, Cai XJ. Primary hepatic leiomyosarcoma successfully treated by transcatheter arterial chemoembolization: A case report. World J Clin Cases. 2019;7(4):525-531.
  20. Matthaei H, Krieg A, Schmelzle M, et al. Long-term survival after surgery for primary
  21. hepatic sarcoma in adults. Arch Surg. 2009;144(4):339-344.