Hepar Lobatum Carcinomatosum Associated with Metastatic Rectal Carcinoma: An Unusual Cause of Liver Dysmorphy

Abstract

Objective: The aim of this study was to present a case of hepar lobatum resulting from metastatic rectal carcinoma. Clinical Presentation and Intervention: A 50-year-old man presented with a 2-year history of bleeding per anum, tenesmus, malaise and weakness. Initially, the patient received neoadjuvant chemoradiotherapy followed by abdominoperineal resection of the rectum. Abdominal computed tomography showed lobar enlargement and lobulated contour, mainly in the left lobe of the liver, but no primary or metastatic lesions were detected. Laparotomy revealed an irregularly lobulated hepatic deformity. Liver biopsy showed a necrotic tumor growth from adenocarcinoma of the rectum in subcapsular localizationof the liver. Conclusion: This case showed a patient with hepar lobatum carcinomatosum caused by metastatic rectal carcinoma. The report further highlights the need for clinicians and surgeons to keep in mind the possibility of hepar lobatum carcinomatosum while caring for rectal carcinoma patients, especially when the lobulated contour of the liver is detected at preoperative imaging studies or when the coarsely lobated liver is encountered during surgery for carcinoma of the rectum.

Hepar lobatum carcinomatosum associated with liver metastases from breast cancer: Report of five cases

“…Liver metastases from the kidney, stomach, nasopharynx cancers have also been associated to that pathology [6] and, in some rare cases, HLC may reveal the primitive neoplasm [3].…”

“…However, in our 2 cases, the striking microscopic finding was areas of sinusoidal dilatation which did not show any occlusion by tumor emboli. This vascular injury would be responsible for a heterogeneous liver perfusion with atrophy of the invaded liver segments and compensatory hypertrophy [5,6]. Many chemotherapy drugs, including alkylating agents (cyclophosphamide), anti-metabolites (methotrexate, 5-FU), cytotoxic antibiotics (doxorubicin, epirubicin, mitomycin, mitoxanthrone) and plant alkaloids (vinblastine, paclitaxel, docetaxel) have been associated to SOS [3,[8][9][10].…”

“…Only a very few cases have been described in the literature [1][2][3][4][5][6][7][8]. In this article, we report the largest series of five similar cases of HLC in patients treated for liver metastases from ductal breast carcinoma and associated with rapid hepatic failure.…”

The Frequency and Significance of Radiologically Detected Indeterminate Pulmonary Nodules in Patients with Colorectal Cancer

“…The mortality of CRC has declined over the last 25 years, with a well-documented 20–25% reduction in CRC mortality rate from 1990 to 2003, due to well-established screening and surgical techniques as well as the development of new targeted therapies for treatment [1,2,3]. In general, 5-fluorouracil-based treatment schedules of either neoadjuvant chemotherapy and/or radiotherapy before surgery or adjuvant chemotherapy treatment are offered to minimize the risk of recurrence and improve the overall outcome.…”

Liver Transplantation in a Patient With Clinical Manifestations of Cryptogenic Cirrhosis: A Case Report of Hepar Lobatum as a Primary Liver Condition

“…The disease was also related to metastatic rectal [12] and gastric [13] carcinomas, and to Hodgkin lymphoma [1,14]. The histologic picture, according to the main theory, is owing to vascular injury by direct neoplastic invasion and its consequent ischemic damage or to the intrahepatic veins involvement by the progression of the stromal reaction associated with the tumor cells [7e9].…”