A 70 year old male) patient was incidentally diagnosed with a Mixed-andeno- neuroendocrine-carcinoma (manec) pT4, pN1, V1, ,L1, Pn1 grading G3, . No metastases. He unterwent a Whipple's procedure with good recovery. He started chemotherapy Cisplatin/Etoposid. The first reevaluation showed 3 "lesions " in his liver suggestive for metastases (60% of examiners) or asymptomatic cholangitis (the other 40% examiners). Without any other intervention the chemotherapy was continued and after 4 months the lesions have all disappeared.
Beeing an extremely maligne cancer type with low survival rates. The question has deep implications for our further planing of therapy.
PubMed did not give any answeres.
In the absence of clinical symptoms and normal biochemical tests,we normally donot say patient has cholangitis.interestingly pt's liver mets diagnosed radiologically during follow up have disappeared.I am not sure wheather they are mets ?Needs further follow up.
It is clearly not a common problem but it exists. I had similar case few years ago – a male patient after PPPD who had two low-attenuating lesions in the left liver at CT, and PET-CT demonstrates hypermetabolic activity (as you can see at the attached figures below). As patient refused chemotherapy we did left hepatectomy. Histology revealed both lesions to be an inflammatory pseudotumors and the presence of marked chronic cholangitis was also noted by pathologists.
This seems to be very similar to our case! Thanks a lot for sharing! This is very interesting. I presume when you say inflamatory pseudotumors you don't mean abscesses?
Thanks again.
Dear Stephan,
Inflammatory pseudotumors of the liver are distinct entity with various etiology. They are solid lesions without liquefication – i.e. they are not abscesses. In analysis of series of 250 pts with liver tumors I had 3 pts with inflammatory pseudotumors misdiagnosed as a malignant lesion. Excluding the patient in the above post they are: one pt 3 years after resection of colon cancer with liver lesion caused by Larva migrans and a 14-year old boy with amoeboma (no liquefication) a year after traveling for holidey in an endemic country. At resection all of them are firm solid lesions and even after cutting the specimen it is not possible to distinguish them from most common malignant liver lesions. Correct diagnosis was made by histology.
Thanks again for the information. This is the MRI and PET with one of the three lesions. at the beginning of chemotherapy (In PET scan the lesion is zoomed out slightly) . Two of them disappeared during chemotherapy (one larger one was not thought to be suspicious did not change). Interistingly tumor marker chromogranin A was slightly rising when the lesions were seen first and is now back to low post-op levels .
Dear Drs. Heberger and Julianov, I had a Whipple operation in August 2016 in Kobe, Japan (I am an associate professor at a Japanese Institute of Science and Technology) to remove a pancreatic adenocarcinoma (stage IIA). My CA19-9 marker post-op became very good,
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