Acute Abdomen Caused by an Impending Rupture of Cystic-Solid Liver Mass

The undifferentiated embryonic sarcoma of the liver (UESL) is an extremely rare malignant mesenchymal tumor with aggressive behavior and poor prognosis, accounting for 0.03% of all resected liver specimens in China. Since UESL has no specific clinical symptoms, many cases of UESL are misdiagnosed or treated with inappropriate surgical mode. Tumoral rupture would significantly impact tumoral TNM staging and patients’ clinical outcomes. This report describes a clinical course of an acute abdomen patient with an upcoming rupture of UESL. Thanks to a successful emergency hepatectomy with a close cyst, the patient remained free of disease at a 15-month follow-up. Separated cystic-solid component of a hepatic mass on CT might be the most important suggestive of an UESL, and uneven cyst fluid, ballooned cyst, blunt liver edge, and effusion surrounding around the cyst might be the useful imaging clues of potential rupture of the cystic-solid liver mass. Emergency surgical removal of the liver mass was evidently promising and worth noting in case of tumor rupture and subsequent risk of tumor seeding.