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Special Feature
January 1, 2004

Image of the Month—Quiz Case

Author Affiliations

GRACE S.ROZYCKIMDFrom the Divisions of Transplant Surgery and Pediatric Gastroenterology,Washington University School of Medicine, St Louis, Mo.

Arch Surg. 2004;139(1):113-114. doi:10.1001/archsurg.139.1.113

An 8-year-old previously healthy girl was first seen with vague complaints of abdominal pain. After several months of treatment for constipation, her parents noted abdominal asymmetry and brought her in for reevaluation. Physical examination revealed a large, firm, right-sided abdominal mass that was mildly tender. Computed tomography of the abdomen and pelvis demonstrated a large soft-tissue mass in the posterior right hemiliver (Figure 1), without any evidence of distant disease or disease in the left hemiliver. Results of chest computed tomography and bone scanning also showed no evidence of distant disease. Laboratory data included a normalα-fetoprotein level, and all hepatitis serologic findings were negative.

The patient underwent exploration through a bilateral subcostal incision with subxiphoid extension. The large mass was immediately evident at entrance to the abdomen, without adherence to adjacent structures or evidence of distant disease (Figure 2). A formal right hemihepatectomy was performed, which resulted in complete resection of the tumor. Pathology evaluation revealed that the tumor measured 13.1 × 9.9 × 6.2 cm and extended to within 0.3 cm of the inked margin. The patient had an uneventful recovery and was discharged in good condition on postoperative day 5.

What Is the Diagnosis?


B.Hepatocellular carcinoma

C.Focal nodular hyperplasia

D.Undifferentiated embryonal sarcoma

Corresponding author: Jeffrey A. Lowell, MD, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8109, St Louis, MO 63110 (e-mail: