Hepatic abscess induced by gastric cancer mimicking differentiated hepatocellular carcinoma

A 58-year-old man was referred to our hospital with right abdominal pain. Contrast-enhanced computed tomography (CECT) showed a rim-enhanced lesion with a fluid collection in the right hepatic lobe. Upper gastrointestinal endoscopy revealed a Borrmann type 1 tumor on the middle gastric body, identified as an adenocarcinoma on pathology. The patient underwent percutaneous transhepatic abscess drainage and was treated with antibiotics. Two weeks after drainage, CECT revealed shrinkage of the abscess; however, the wall showed contrast enhancement. Needle biopsy was performed for the liver tumor, and it suggested the possibility of highly differentiated hepatocellular carcinoma. The patient first underwent gastrectomy, and the liver tumor was followed with CECT. Two months after surgery, CECT revealed that the liver tumor had vanished. Liver abscesses and infectious tumors can be difficult to differentiate between; therefore, careful scrutiny is essential before treatment. We experienced a case of Streptococcus intermedius related liver abscess induced by gastric cancer. Contrast effect was observed on the tumor wall, hence it was difficult to distinguish it from differentiated hepatocellular carcinoma even after tumor biopsy.image