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Benign metastasizing pleomorphic adenoma in liver mimicking synchronic metastatic disease from colorectal cancer: a case report with emphasis on imaging findings.

Young VS, Viktil E, Løberg EM, Enden T - Acta Radiol Open (2015)

Bottom Line: Pleomorphic adenoma of the parotid gland with metastases to the liver is a rare etiology of focal liver lesions, and there are no described pathognomonic imaging features.We report a patient who presented with a newly diagnosed rectal cancer and multiple cystic liver lesions suspicious of mucinous synchronous liver metastases.Following chemotherapy no reduction in the number or size of the liver lesions was observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Oslo University Hospital, Oslo, Norway.

ABSTRACT
Pleomorphic adenoma of the parotid gland with metastases to the liver is a rare etiology of focal liver lesions, and there are no described pathognomonic imaging features. We report a patient who presented with a newly diagnosed rectal cancer and multiple cystic liver lesions suspicious of mucinous synchronous liver metastases. Following chemotherapy no reduction in the number or size of the liver lesions was observed. The patient was re-evaluated and a biopsy of a lesion was performed. The specimen showed a metastasis from a pleomorphic adenoma of the parotid gland for which the patient had been treated 20 years earlier. The case illustrates how a thorough medical history can be crucial when a standard diagnostic imaging workup for colorectal cancer metastases is uncertain, and how a biopsy, though regarded as contraindicated due to the risk of tumor cell dissemination, can be required to secure a correct diagnosis.

No MeSH data available.


Related in: MedlinePlus

A four phase CT scan through the liver. (a) Pre-contrast axial image showing two irregular low density (40 HU) lesions of 2 cm in segments II and VII. None of the lesions showed contrast enhancement. (b) Arterial phase. (c) Portovenous phase. (d) Late phase (5 min).
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fig1-2058460115594199: A four phase CT scan through the liver. (a) Pre-contrast axial image showing two irregular low density (40 HU) lesions of 2 cm in segments II and VII. None of the lesions showed contrast enhancement. (b) Arterial phase. (c) Portovenous phase. (d) Late phase (5 min).

Mentions: A 65-year-old woman with no previous history of malignant disease was referred to our university hospital with a newly diagnosed invasive adenocarcinoma of the rectosigmoidum, stage III. A contrast-enhanced computed tomography (CT) scan of the abdomen revealed one sub-capsular lens-shaped hypodense lesion with a maximum diameter of 6.0 cm in segment VII, and five smaller lesions of 0.5–2.0 cm scattered in the parenchyma (Fig. 1). The smaller lesions were oval and/or lobulated in shape, some with irregular outlines. The lens-shaped lesion had pre-contrast attenuation in the range of 30–36 HU, while the 1.0–2.0 cm lesions were 23–44 HU (Fig. 1a), indicating a content of protein-rich fluid of all six lesions. Following injection of intravenous contrast none of the lesions showed enhancement in the arterial (Fig. 1b), the portal venous (Fig. 1c), or the late phase (Fig. 1d). To further evaluate whether the lesions could represent hemorrhagic/inflammatory cysts or mucinous/necrotic metastases from the rectosigmoid tumor, both ultrasound (US) and magnetic resonance imaging (MRI) were performed.Fig. 1.


Benign metastasizing pleomorphic adenoma in liver mimicking synchronic metastatic disease from colorectal cancer: a case report with emphasis on imaging findings.

Young VS, Viktil E, Løberg EM, Enden T - Acta Radiol Open (2015)

A four phase CT scan through the liver. (a) Pre-contrast axial image showing two irregular low density (40 HU) lesions of 2 cm in segments II and VII. None of the lesions showed contrast enhancement. (b) Arterial phase. (c) Portovenous phase. (d) Late phase (5 min).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4548729&req=5

fig1-2058460115594199: A four phase CT scan through the liver. (a) Pre-contrast axial image showing two irregular low density (40 HU) lesions of 2 cm in segments II and VII. None of the lesions showed contrast enhancement. (b) Arterial phase. (c) Portovenous phase. (d) Late phase (5 min).
Mentions: A 65-year-old woman with no previous history of malignant disease was referred to our university hospital with a newly diagnosed invasive adenocarcinoma of the rectosigmoidum, stage III. A contrast-enhanced computed tomography (CT) scan of the abdomen revealed one sub-capsular lens-shaped hypodense lesion with a maximum diameter of 6.0 cm in segment VII, and five smaller lesions of 0.5–2.0 cm scattered in the parenchyma (Fig. 1). The smaller lesions were oval and/or lobulated in shape, some with irregular outlines. The lens-shaped lesion had pre-contrast attenuation in the range of 30–36 HU, while the 1.0–2.0 cm lesions were 23–44 HU (Fig. 1a), indicating a content of protein-rich fluid of all six lesions. Following injection of intravenous contrast none of the lesions showed enhancement in the arterial (Fig. 1b), the portal venous (Fig. 1c), or the late phase (Fig. 1d). To further evaluate whether the lesions could represent hemorrhagic/inflammatory cysts or mucinous/necrotic metastases from the rectosigmoid tumor, both ultrasound (US) and magnetic resonance imaging (MRI) were performed.Fig. 1.

Bottom Line: Pleomorphic adenoma of the parotid gland with metastases to the liver is a rare etiology of focal liver lesions, and there are no described pathognomonic imaging features.We report a patient who presented with a newly diagnosed rectal cancer and multiple cystic liver lesions suspicious of mucinous synchronous liver metastases.Following chemotherapy no reduction in the number or size of the liver lesions was observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Oslo University Hospital, Oslo, Norway.

ABSTRACT
Pleomorphic adenoma of the parotid gland with metastases to the liver is a rare etiology of focal liver lesions, and there are no described pathognomonic imaging features. We report a patient who presented with a newly diagnosed rectal cancer and multiple cystic liver lesions suspicious of mucinous synchronous liver metastases. Following chemotherapy no reduction in the number or size of the liver lesions was observed. The patient was re-evaluated and a biopsy of a lesion was performed. The specimen showed a metastasis from a pleomorphic adenoma of the parotid gland for which the patient had been treated 20 years earlier. The case illustrates how a thorough medical history can be crucial when a standard diagnostic imaging workup for colorectal cancer metastases is uncertain, and how a biopsy, though regarded as contraindicated due to the risk of tumor cell dissemination, can be required to secure a correct diagnosis.

No MeSH data available.


Related in: MedlinePlus