Published online Dec 27, 2013. doi: 10.4254/wjh.v5.i12.696
Revised: November 5, 2013
Accepted: November 18, 2013
Published online: December 27, 2013
Processing time: 114 Days and 22 Hours
A 68-year-old Caucasian man with hepatitis C virus-related cirrhosis was admitted to our Unit in February 2010 for a diagnostic evaluation of three centimetric hypoechoic focal liver lesions detected by regular surveillance ultrasound. The subsequent computer tomography (CT) led to a diagnosis of unifocal hepatocellular carcinoma (HCC) in VI hepatic segment, defined the other two nodules in the VI and VII segment as suspected metastases, and showed a luminal narrowing with marked segmental circumferential thickening of the hepatic flexure of the colon. Colonoscopy detected an ulcerated, bleeding and stricturing lesion at the hepatic flexure, which was subsequently defined as adenocarcinoma with a moderate degree of differentiation at histological examination. Finally, ultrasound-guided liver biopsy of the three focal liver lesions confirmed the diagnosis of HCC for the nodule in the VI segment, and characterized the other two lesions as metastases from colorectal cancer. The patient underwent laparotomic right hemicolectomy with removal of thirty-nine regional lymph nodes (three of them tested positive for metastasis at histological examination), and simultaneous laparotomic radio-frequency ablation of both nodule of HCC and metastases. The option of adjuvant chemotherapy was excluded because of the post-surgical onset of ascites. Abdomen CT and positron emission tomography/CT scans performed after 1, 6 and 12 mo highlighted a complete response to treatments without any radiotracer accumulation. After 18 mo, the patient died due to progressive liver failure. Our experience emphasizes the potential coexistence of two different neoplasms in a cirrhotic liver and the complexity in the proper diagnosis and management of the two tumours.
Core tip: A 68-year-old man with hepatitis C virus-related cirrhosis was admitted to our Unit for a diagnostic evaluation of three focal liver lesions detected by regular surveillance ultrasound. Computer tomography scans of abdomen allowed a diagnosis of single nodule hepatocellular carcinoma (HCC) and showed two centimetric liver nodules suspected for metastases and a luminal narrowing with thickening of the colon. The subsequent colonoscopy and ultrasound-guided biopsy of the three focal liver lesions confirmed a diagnosis of colorectal cancer with liver metastases together with a single nodule HCC. Our experience highlights the potential coexistence of two different neoplasms in a cirrhotic liver and the complexity in the proper diagnosis and management of the two tumours.