Case Report
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World J Hepatol. Jun 27, 2013; 5(6): 340-344
Published online Jun 27, 2013. doi: 10.4254/wjh.v5.i6.340
Multiple focal nodular hyperplasias induced by oxaliplatin-based chemotherapy
Matteo Donadon, Luca Di Tommaso, Massimo Roncalli, Guido Torzilli
Matteo Donadon, Guido Torzilli, Liver Surgery Unit, Department of General Surgery, University of Milan, Humanitas Clinical and Research Center, 20089 Rozzano, Milan, Italy
Luca Di Tommaso, Massimo Roncalli, Department of Pathology, University of Milan, Humanitas Clinical and Research Center, 20089 Rozzano, Milan, Italy
Author contributions: Donadon M designed and wrote the manuscript; Di Tommaso L reviewed the anatomo-pathological data; Roncalli M and Torzilli G reviewed and approved the manuscript.
Correspondence to: Matteo Donadon, MD, Liver Surgery Unit, Department of General Surgery, University of Milan, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy. matteo.donadon@humanitas.it
Telephone: +39-2-82244502 Fax: +39-2-82244590
Received: April 19, 2013
Revised: May 19, 2013
Accepted: June 1, 2013
Published online: June 27, 2013
Processing time: 68 Days and 17.4 Hours
Abstract

Focal nodular hyperplasia (FNH) is a benign condition that affects normal liver with low prevalence. Recently, the extensive use of oxaliplatin to treat patients with colorectal cancer has been reported to be associated with the development of different liver injuries, as well as focal liver lesions. The present work describes two patients with multiple bilateral focal liver lesions misdiagnosed as colorectal liver metastases, and treated with liver resection. The first patient had up to 15 small bilateral focal liver lesions, with magnetic resonance imaging consistent with colorectal liver metastases (CLM), and fluorodeoxyglucose (FDG)-positron emission tomography (PET) negative. The second patient had up to 5 small focal liver lesions, with computed tomography consistent with CLM, and FDG-PET negative. They had parenchyma sparing liver surgery, with uneventful postoperative course. At the histology the diagnosis was multiple FNHs. The risks of oxaliplatin-based chemotherapy regimens in development of liver injuries, such as FNH, should not be further denied. The value of the modern multidisciplinary management of patients with colorectal cancer relies also on the precise estimation of the risk/benefit for each patient.

Keywords: Focal nodular hyperplasia; Colorectal cancer; Colorectal liver metastasis; Oxaliplatin; Systemic chemotherapy

Core tip: This report describes two interesting cases of patients who developed multiple focal nodular hyperplasias during oxaliplatin-based therapy for colorectal cancer. Such multiple bilateral focal liver lesions were misdiagnosed as colorectal liver metastases, and treated with liver resection. A review of the cases revealed that in both cases the fluorodeoxyglucose-positron emission tomography was negative. A brief review of the literature together with the authors’ comments is included.