Metachronous Potentially Convertible Liver-Only Disease at Presentation

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CASE 13: A 40-year-old man initially presents with a transient bleed from a K-ras wild-type primary tumor located in the cecum and is treated with colonic resection, ahead of imaging or CEA evaluation, by a local surgeon. Patient now presents postoperatively with elevated CEA and radiologic evidence of a central solitary metastasis in the right/caudate liver lobe. Left liver lobe appears small but free of metastases. (Presenter Dr. Alan Venook, see other cases by Dr. Venook)

CASE 14: A 65-year-old woman with stage-unknown CRC previously treated by resection of the primary lesion without systemic therapy now presents 4 years after initial diagnosis complaining of abdominal “fullness.” CT/PET reveals a 6- to 8-cm solitary and centrally located liver metastasis, spanning across both the right and left lobes. (Presenter Dr. Alan Venook, see other cases by Dr. Venook)

CASE 15: A 72-year-old woman presents 5 years after preoperative chemoradiation therapy and an abdominal perineal resection for a T3N2 adenocarcinoma, complaining of right upper quadrant discomfort. CT shows 8 bilobar liver lesions ranging from 2 to 5 centimeters in size, 2 of which appear to reside in the lateral left lobe and 6 in the posterior portion of the right lobe. (Presenter Dr. Nicholas Petrelli, see other cases by Dr. Petrelli)

CASE 16: A 41-year-old man initially presented with Stage IV colon cancer and underwent a palliative right hemicolectomy. Metastatic disease was confined to the liver but notably occupied most of the right lobe, abutting the inferior vena cava. Several smaller lesions of undetermined significance were found in the left hemiliver. Prior to surgical referral, the patient completed 10 cycles of FOLFOX and bevacizumab, with CEA response but limited radiologic response. He then received transarterial chemoembolization for 2 cycles. He now presents 1 year after the initial diagnosis with isolated hepatic metastases, somewhat unchanged from baseline. (Presenter Dr. Michael Choti, see other cases by Dr. Choti)

CASE 17: A 51-year-old man presented with anemia, and a colonoscopy revealed cecal cancer. Patient underwent a right hemicolectomy, and pathology confirmed the tumor to be T3N1Mx. He was then referred to a medical oncologist for adjuvant therapy, and staging CT identified 3 hepatic metastases, 1 located centrally, 1 near the right portal pedicle and 1 adjacent to the gall bladder. Uninvolved segments I, II and III represent < 20% functional liver reserve by volumetric studies. (Presenter Dr. Michael Choti, see other cases by Dr. Choti)

CASE 18: A 48-year-old woman with acute abdominal pain was found to have a pelvic abscess secondary to a perforated sigmoid tumor associated with extensive hepatic metastases. Bilobar liver lesions ranged in size from 1 to 5 centimeters and demonstrated involvement of almost every segment. Emergent abscess drainage and resection of the sigmoid tumor were performed. (Presenter Dr. John Primrose, see other cases by Dr. Primrose)

CASE 19: A 42-year-old man underwent resection for a Stage II T3/N0 colonic tumor, followed by postoperative adjuvant therapy with 5-FU/LV. Three years after diagnosis, surveillance CT revealed a single 3-cm hepatic lesion abutting a major artery in segment VIII of the right lobe. PET showed no other liver involvement and no extrahepatic disease. (Presenter Dr. Daniel Haller, see other cases by Dr. Haller)

CASE 20: A 62-year-old woman was diagnosed 3 years ago with a T3N1 low rectal tumor and received neoadjuvant chemoradiation therapy followed by resection with permanent colostomy and 4 additional cycles of postoperative 5-FU/LV. She now presents with surveillance CT evidence of 5 unique bilobar hepatic metastases, including segments VI, VII, VIII and II. The lesion in segment VIII appears to be flush against a major aortic branch vessel. The 2 tumors in the left lobe are not geographically amenable to radiofrequency ablation. (Presenter Dr. Daniel Haller, see other cases by Dr. Haller)

CASE 21: A 54-year-old woman with a history of Stage III colon cancer treated with hemicolectomy and 6 months of adjuvant FOLFOX presents 20 months after resection with elevated CEA and PET/CT evidence of 4 hepatic metastases involving liver segments IV, V, VII and VIII. There appeared to be involvement of the middle hepatic vein and tumor proximity to both the right and left hepatic veins. No extrahepatic disease was identified, but the caudate and left lateral lobe comprised only 18 percent of the total liver volume. (Presenter Dr. Steven Curley, see other cases by Dr. Curley)

CASE 22: A 60-year-old woman previously underwent a low anterior resection for a T3N0 rectosigmoid tumor with no adjunctive systemic therapy. Three years after resection, she complained of early satiety and CT indicated a large liver metastasis involving segments II, III, IV and VIII, encasing the left and middle hepatic veins and abutting the right hepatic vein. No extrahepatic disease was identified. (Presenter Dr. Steven Curley, see other cases by Dr. Curley)

CASE 23: A 69-year-old woman presented with colon cancer and a solitary but poorly located, isolated hepatic metastasis in segment VIII of the right hemiliver, abutting the junction of the inferior vena cava, median and right hepatic veins. She underwent a right colectomy at her primary institution, followed by 2 cycles of FOLFOX, and was seen at a tertiary center for surgical consultation, now showing some evidence of liver toxicity and slight disease progression while receiving chemotherapy. (Presenter Dr. René Adam, see other cases by Dr. Adam)

CASE 24: A 50-year-old man with rectal cancer and synchronous hepatic metastases underwent a low anterior resection of the primary tumor and received postoperative FU/leucovorin resulting in disappearance of his liver lesions. One year later, he presented with bilobar liver-only recurrence (1 large lesion in segment VII and multiple small metastases in the left lobe). (Presenter Dr. René Adam, see other cases by Dr. Adam)

CASE 25: A 68-year-old man underwent a colectomy for a sigmoid adenocarcinoma and was found intraoperatively to have bilobar synchronous hepatic metastases. Multiple liver lesions appeared to surround the hepatic vein and inferior vena cava, such that the disease was unresectable at presentation. Patient recovered from his colectomy and exploratory laparotomy without complication. (Presenter Dr. René Adam, see other cases by Dr. Adam)

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