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Fluorouracil implants caused a diaphragmatic tumor to be misdiagnosed as liver metastasis: a case report

View Article: PubMed Central - PubMed

ABSTRACT

Background: Fluorouracil implants are widely used in peritoneal interstitial chemotherapy. Curative effects have been obtained, but implants have also caused some complications.

Case presentation: We performed an analysis of a 66-year-old male patient’s case history, as well as conventional pathological analysis and Raman spectroscopic detection of the diaphragmatic tumor. We also analyzed the underlying causes of this condition to prevent complications and reduce misdiagnoses in future cases. The patient had a history of peritoneal fluorouracil implantation. Pathological analysis of the diaphragmatic mass revealed foreign particles, and Raman detection showed that the mass contained fluorouracil.

Conclusion: Fluorouracil implants may persist due to the high concentrations of this drug used in peritoneal chemotherapy. This finding should provide guidance and improve the application of peritoneal implants. In clinical trials, and the diagnosis of liver metastasis should be based on pathological results.

No MeSH data available.


Related in: MedlinePlus

Diaphragmatic tumor (hematoxylin and eosin, magnification × 100)
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Fig2: Diaphragmatic tumor (hematoxylin and eosin, magnification × 100)

Mentions: A 66-year-old male patient was diagnosed with sigmoid colon cancer by colonoscopy 3 months previously. No neoadjuvant therapy was done before surgery. The surgery consisted of sigmoid colon cancer resection performed at Qilu Hospital of Shandong University. It was an open operation. When exploring the abdomen, liver and peritoneum, no metastatic nodules were found, but a tumor, about 5 × 3 cm in size, was located in the sigmoid colon. The tumor was removed, an anastomosis was done at the rectum end of the sigmoid colon and plasma muscularis sutures embedded the anastomosis. 800 mg Sinofuan was planted in the abdomen for adjuvant chemotherapy, and a drainage tube was installed to protect the anastomosis. The operation went smoothly. Postoperatively, the patient presented abdominal pain, fever, and abdominal fluid. Encapsulated fluid measuring approximately 6.3 cm × 3.4 cm was detected in the right upper abdominal cavity, appearing as an echo-free space on ultrasonic screening. After paracentesis drainage and anti-infection treatment, the patient’s condition improved and he was discharged. One month ago, the patient came to our hospital for further chemotherapy. Physical examination showed no abnormalities. Computed tomography (CT) examination revealed a right liver lobe lesion of lower density on the eighth segment, with a diameter of approximately 2.0 cm. On CT the arterial phase, portal venous phase, and venous phase showed no obvious enhancement. However, the patient had normal levels of alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), gamma-glutamyltransferase (GGT), and lactate dehydrogenase (LDH). Before the colon cancer surgery they were also at normal levels. Combined with the history of colon cancer surgery and the CT manifestations, this case was initially diagnosed as liver metastasis. After three rounds of chemotherapy, CT showed no significant changes compared with the previous examination. The patient was then transferred to the surgical ward for further surgery. During surgery, a 3 cm × 2 cm × 0.7 cm encapsulated white porcelain-like tumor was detected on the diaphragm oppressing the liver, which caused liver capsule depression with local shallow sclerosis (see Fig. 1). The pathological results (see Figs. 2 and 3) showed the diaphragmatic surface of the tumor to be highly necrotic, oozing, and containing cylindrical foreign bodies. In addition, there was nodular surface hemorrhaging and necrosis, subcapsular inflammatory cell infiltration, fibrosis, and small bile duct hyperplasia.Fig. 1


Fluorouracil implants caused a diaphragmatic tumor to be misdiagnosed as liver metastasis: a case report
Diaphragmatic tumor (hematoxylin and eosin, magnification × 100)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5037584&req=5

Fig2: Diaphragmatic tumor (hematoxylin and eosin, magnification × 100)
Mentions: A 66-year-old male patient was diagnosed with sigmoid colon cancer by colonoscopy 3 months previously. No neoadjuvant therapy was done before surgery. The surgery consisted of sigmoid colon cancer resection performed at Qilu Hospital of Shandong University. It was an open operation. When exploring the abdomen, liver and peritoneum, no metastatic nodules were found, but a tumor, about 5 × 3 cm in size, was located in the sigmoid colon. The tumor was removed, an anastomosis was done at the rectum end of the sigmoid colon and plasma muscularis sutures embedded the anastomosis. 800 mg Sinofuan was planted in the abdomen for adjuvant chemotherapy, and a drainage tube was installed to protect the anastomosis. The operation went smoothly. Postoperatively, the patient presented abdominal pain, fever, and abdominal fluid. Encapsulated fluid measuring approximately 6.3 cm × 3.4 cm was detected in the right upper abdominal cavity, appearing as an echo-free space on ultrasonic screening. After paracentesis drainage and anti-infection treatment, the patient’s condition improved and he was discharged. One month ago, the patient came to our hospital for further chemotherapy. Physical examination showed no abnormalities. Computed tomography (CT) examination revealed a right liver lobe lesion of lower density on the eighth segment, with a diameter of approximately 2.0 cm. On CT the arterial phase, portal venous phase, and venous phase showed no obvious enhancement. However, the patient had normal levels of alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), gamma-glutamyltransferase (GGT), and lactate dehydrogenase (LDH). Before the colon cancer surgery they were also at normal levels. Combined with the history of colon cancer surgery and the CT manifestations, this case was initially diagnosed as liver metastasis. After three rounds of chemotherapy, CT showed no significant changes compared with the previous examination. The patient was then transferred to the surgical ward for further surgery. During surgery, a 3 cm × 2 cm × 0.7 cm encapsulated white porcelain-like tumor was detected on the diaphragm oppressing the liver, which caused liver capsule depression with local shallow sclerosis (see Fig. 1). The pathological results (see Figs. 2 and 3) showed the diaphragmatic surface of the tumor to be highly necrotic, oozing, and containing cylindrical foreign bodies. In addition, there was nodular surface hemorrhaging and necrosis, subcapsular inflammatory cell infiltration, fibrosis, and small bile duct hyperplasia.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Fluorouracil implants are widely used in peritoneal interstitial chemotherapy. Curative effects have been obtained, but implants have also caused some complications.

Case presentation: We performed an analysis of a 66-year-old male patient’s case history, as well as conventional pathological analysis and Raman spectroscopic detection of the diaphragmatic tumor. We also analyzed the underlying causes of this condition to prevent complications and reduce misdiagnoses in future cases. The patient had a history of peritoneal fluorouracil implantation. Pathological analysis of the diaphragmatic mass revealed foreign particles, and Raman detection showed that the mass contained fluorouracil.

Conclusion: Fluorouracil implants may persist due to the high concentrations of this drug used in peritoneal chemotherapy. This finding should provide guidance and improve the application of peritoneal implants. In clinical trials, and the diagnosis of liver metastasis should be based on pathological results.

No MeSH data available.


Related in: MedlinePlus