Munajj Huq, DO1, Julia Janecki, DO, MSPH2, Jaspreet Ghumman, DO1, Tara Eastin, DO1 1McLaren Macomb Hospital, Mt. Clemens, MI; 2McLaren Macomb, Royal Oak, MI Introduction: Malignant hepatic lesions are classified into primary malignancies or hepatic metastasis (most frequent). Necrotic liver masses may be associated with a solitary necrotic nodule, which is usually benign, or large and rapidly progressive hepatic tumors or metastasis. Here we present a case of a squamous cell carcinoma (SCC) of the lung that was diagnosed based on the acute development of a substantially large necrotic liver mass on imaging.
Case Description/
Methods: A 71-year-old female with a past medical history of a pulmonary nodule, stage IIIb chronic kidney disease, presented to the outpatient clinic for follow-up of abnormal imaging findings. History of a 1.3 cm right upper lobe lung nodule on screening CT chest without contrast six months. A few months later, the patient developed new onset hemoptysis and repeat CT chest without contrast demonstrated an increased size of the RUL nodule (3.1cm), increased size of a right adrenal mass, and the new development of a centrally necrotic mass in the right hepatic lobe, measuring 6.5 x 10 x 9.3 cm. Due to concerning CT findings, the patient underwent PET scan which demonstrated a cavitary hypermetabolic RUL lung mass (3.5 x 3.3 cm) and a large intralobar necrotic mass spanning both the right and left hepatic lobes (10.0 x 7.1 cm). The patient was sent for hepatic mass biopsy, which resulted in a positive diagnosis for squamous cell carcinoma, suspected lung primary. The patient was evaluated by oncology and started pembrolizumab along with palliative radiation therapy, with a significant decrease in the size of lung and liver masses after six months of treatment. Discussion: The etiology of large necrotic hepatic masses is not well discussed in the current literature. Our case shows a significantly large necrotic liver mass that was found to be a metastasis from primary lung SCC. This is an unusual presentation of hepatic metastasis given the rapid development and substantial size of the hepatic mass, which typically range from 1-3 cm in diameter. Additionally, the patient’s response to six months of pembrolizumab demonstrated an impressive reduction in the hepatic metastasis and warrants further investigation into the use of the drug for the treatment of late-stage squamous cell carcinoma of the lung.
Disclosures: Munajj Huq indicated no relevant financial relationships. Julia Janecki indicated no relevant financial relationships. Jaspreet Ghumman indicated no relevant financial relationships. Tara Eastin indicated no relevant financial relationships.
Munajj Huq, DO1, Julia Janecki, DO, MSPH2, Jaspreet Ghumman, DO1, Tara Eastin, DO1. P1753 - An Unusual Presentation a Metastatic Hepatic Tumor with Rapid Resolutions Following Treatment Pembrolizumab, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
