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Myospherulosis is a rare interaction of extravasated erythrocytes and lipids, resulting in the degeneration of erythrocytes, which are subsequently enclosed by a lipid membrane. Thus, histologically typical, saccular parent bodies containing variable numbers of approximately 6 µm spherules are formed.1 The lesions are usually small (few millimetres to few centimeters) and do not cause any symptoms except swelling at the involved site. Differential diagnoses include carcinomas, metastases, osteofibrosis or echinococcosis due to alikeness in radiographic imaging and morphology. In addition, myospherulosis can be misdiagnosed as infections by fungi or algae due to histopathological similarity.2 In most cases, myospherulosis is caused by iatrogenic exposure to petroleum-based material, however, rare cases without exogenic lipid exposure have been described, and only one case of hepatic myospherulosis following portal vein embolisation has been published.3–7 To the best of our knowledge, this is the first case of spontaneous myospherulosis of the liver parenchyma presenting with an exceptional size.
A 76-year-old female patient (height, 165 cm; weight, 78 kg; body mass index, 28.7 kg/m2) presented without any complaints at a rehabilitation centre. Eighteen months earlier, an invasive ductal mamma carcinoma (pT1c, pN0 (sn), R0, G2, L1, V0) was transmamillary resected, and an adjuvant radiochemotherapy (59.4 Gray, trastuzumab and letrozole) was applied. The clinical examination revealed a large liver tumour, and the patient was transferred to our university hospital. Abdominal ultrasound showed a 12×11×11 cm-sized, sharply demarcated tumour with a sponge-like content (figure 1) of unknown origin and dignity. Besides this tumour, at least two …