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A 50-year-old woman was referred to surgical oncology after computed tomography for
self-limiting abdominal pain revealed arterial enhancing hepatic lesions (Figure 1) and an arterial enhancing subcentimeter pancreatic lesion. Patient did not endorse
any abdominal symptoms, unintentional weight loss, changes in her bowel habits, or
other concerning symptoms. Her review of system was only notable for heavy menses
throughout her adulthood. Her medical history was notable for gastroesophageal reflux
disease currently on anti-acid medication. She had no prior surgical history or relevant
family history in first- and second-degree family members. She smoked 1 to 2 cigarettes
per week for the past 30 years with occasional alcohol consumption. A recent esophagogastroduodenoscopy,
which revealed gastritis and colonoscopy which was normal. On physical exam, she was
found to have oral telangiectatic lesions (Figure 2), and no scleral icterus, jaundice, signs of liver dysfunction, hepatomegaly, abdominal
discomfort, and mass or blood on rectal exam. Her hemoglobin was 12.3, and her remaining
laboratory and tumor markers were unremarkable. Percutaneous liver tumor biopsy was
non-diagnostic.
Figure 1CT abdomen with IV contrast demonstrate 2 irregular enhancing hepatic lesions (white arrows).
