Liver Metastases with Simultaneous Extrahepatic Disease (to Lung or Portal Nodes)

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CASE 45: A 60-year-old man previously treated with adjuvant 5-FU and leucovorin for primary CRC presents 3 years after initial diagnosis with elevated transaminases after undergoing a routine liver function test while receiving cholesterol-lowering medications. CT shows a solitary 4-cm liver lesion in the right lobe and an enlarged porta hepatis node but no other obvious extrahepatic disease. Left lobe appears normal in size and without evidence of metastasis. (Presenter Dr. Alan Venook, see other cases by Dr. Venook)

CASE 46: A 60-year-old man status post right hemicolectomy for Stage II colon cancer presents at 1-year follow-up with rising CEA levels. CT reveals 2 metastases in the peripheral right liver lobe, each measuring less than 2 centimeters. PET confirms the 2 small lesions but also demonstrates uptake in the porta hepatis suspicious of periportal lymph node involvement. (Presenter Dr. Michael Choti, see other cases by Dr. Choti)

CASE 47: A 75-year-old woman with a history of Stage III colon cancer treated with resection and adjuvant FOLFOX now presents 18 months after initial diagnosis with rising CEA levels. PET/CT indicates 2 liver metastases confined to the right lobe and 2 potentially resectable small left lung metastases. (Presenter Dr. Michael Choti, see other cases by Dr. Choti)

CASE 48: A 54-year-old obese man underwent resection for T3N2 colon cancer followed by 9 cycles of adjuvant FOLFOX. Two years later a rise in CEA prompted a PET/CT scan, which revealed a solitary 2-cm lung nodule and 3 right-sided hepatic metastases, all measuring less than 3 centimeters. No further disease was identified. (Presenter Dr. Daniel Haller, see other cases by Dr. Haller)

CASE 49: A 32-year-old man with HNPCC underwent an extended right hemicolectomy for Stage III disease (12 nodes involved). He received 3 months of adjuvant 5-FU/LV but shortly thereafter experienced a CEA rise and PET/CT revealed 3 liver metastases involving segments III, IV and VI in addition to enlarged and FDG-avid porta hepatis lymph nodes. No additional sites of disease were identified. (Presenter Dr. Steven Curley, see other cases by Dr. Curley)

CASE 50: A 64-year-old man underwent a sigmoid colectomy for Stage II colon cancer and received 6 months of adjuvant 5-FU/LV. Five years later surveillance CT revealed a solitary right lower lung nodule and 2 large hepatic metastases measuring 8 and 10 centimeters and occupying much of the right lobe of the liver, encroaching on but not involving the left lobe. No additional sites of disease were identified. (Presenter Dr. Steven Curley, see other cases by Dr. Curley)

CASE 51: A 38-year-old woman with rectal cancer, synchronous bilateral liver metastases (one 10-cm lesion in the right lobe, multiple small lesions in the left lobe) and a left pulmonary metastasis underwent chemoradiation therapy, followed by second-line raltitrexed/oxaliplatin and a subsequent low anterior resection of the primary. Postoperatively, the patient began another systemic regimen, irinotecan/cetuximab, yielding a partial response of her residual liver and lung disease. She now self-refers to a tertiary center for further surgical evaluation. (Presenter Dr. René Adam, see other cases by Dr. Adam)

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