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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

MRI of the liver with and without SPIO. (a) Axial T2W sequence with fat suppression showing two hyper intense, lobulated cyst-like lesions in segments II and IV, and one 6 cm sub-capsular lens-shaped lesion in segment VII. (b) Following SPIO four additional sub-centimeter lesions were detected.
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fig3-2058460115594199: MRI of the liver with and without SPIO. (a) Axial T2W sequence with fat suppression showing two hyper intense, lobulated cyst-like lesions in segments II and IV, and one 6 cm sub-capsular lens-shaped lesion in segment VII. (b) Following SPIO four additional sub-centimeter lesions were detected.

Mentions: To evaluate the presence of additional lesions an MRI exam using the liver specific MRI contrast agent super-paramagnetic iron oxide (SPIO) was performed. SPIO accumulates in the reticuloendothelial system (RES) of the liver, while the cells of most malignant liver lesions do not contain RES. The exam detected another six sub-centimeter lesions; all 11 lesions showed high signal relative to liver parenchyma on T2-weighted (T2W) sequences (Fig. 3a), and low signal on T1-weighted (T1W) sequences, indicating high water content. In addition the MRI confirmed the previous imaging findings of a cystic, lobulated appearance with central septations. Accordingly the suspicion of cystic metastases with necrosis or mucin content were maintained (Fig. 3b).Fig. 3.


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)

MRI of the liver with and without SPIO. (a) Axial T2W sequence with fat suppression showing two hyper intense, lobulated cyst-like lesions in segments II and IV, and one 6 cm sub-capsular lens-shaped lesion in segment VII. (b) Following SPIO four additional sub-centimeter lesions were detected.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig3-2058460115594199: MRI of the liver with and without SPIO. (a) Axial T2W sequence with fat suppression showing two hyper intense, lobulated cyst-like lesions in segments II and IV, and one 6 cm sub-capsular lens-shaped lesion in segment VII. (b) Following SPIO four additional sub-centimeter lesions were detected.
Mentions: To evaluate the presence of additional lesions an MRI exam using the liver specific MRI contrast agent super-paramagnetic iron oxide (SPIO) was performed. SPIO accumulates in the reticuloendothelial system (RES) of the liver, while the cells of most malignant liver lesions do not contain RES. The exam detected another six sub-centimeter lesions; all 11 lesions showed high signal relative to liver parenchyma on T2-weighted (T2W) sequences (Fig. 3a), and low signal on T1-weighted (T1W) sequences, indicating high water content. In addition the MRI confirmed the previous imaging findings of a cystic, lobulated appearance with central septations. Accordingly the suspicion of cystic metastases with necrosis or mucin content were maintained (Fig. 3b).Fig. 3.

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