Multiple focal nodular hyperplasias induced by oxaliplatin-based chemotherapy

Abstract

Focal nodular hyperplasia (FNH) is a benign condition that affects normal liver with low prevalence. Recently, the extensive use of oxaliplatin to treat patients with colorectal cancer has been reported to be associated with the development of different liver injuries, as well as focal liver lesions. The present work describes two patients with multiple bilateral focal liver lesions misdiagnosed as colorectal liver metastases, and treated with liver resection. The first patient had up to 15 small bilateral focal liver lesions, with magnetic resonance imaging consistent with colorectal liver metastases (CLM), and fluorodeoxyglucose (FDG)-positron emission tomography (PET) negative. The second patient had up to 5 small focal liver lesions, with computed tomography consistent with CLM, and FDG-PET negative. They had parenchyma sparing liver surgery, with uneventful postoperative course. At the histology the diagnosis was multiple FNHs. The risks of oxaliplatinbased chemotherapy regimens in development of liver injuries, such as FNH, should not be further denied.The value of the modern multidisciplinary management of patients with colorectal cancer relies also on the precise estimation of the risk/benefit for each patient.

Hepatic changes after treatment with oxaliplatin

“…Macroscopic nodules with radiological and pathological characteristics identical to those of FNH-like lesions have been related to various hepatic conditions ( 5 ) such as cirrhosis ( 6 ) , vascular changes such as Budd-Chiari syndrome ( 6 ) , and, more recently, the use of oxaliplatin-based chemotherapy regimens ( 7 , 8 ) , as in the case reported here. …”

Multiple Liver Lesions After Oxaliplatin-Based Chemotherapy for Colorectal Cancer

“…2 More recently, the appearance of multiple hepatic FNHs after oxaliplatin-based chemotherapy was reported, as well. 3 One can hypothesize that oxaliplatin-induced distortion in intrahepatic vascular flow might give rise to the formation of these regenerative-type benign hepatic tumors.…”

Liver Multiacinar Regenerative Nodules: Imaging Findings and Clinical Implications

“…[11][12][13] Particularly, the use of oxaliplatin-based compounds has been associated with such FNH-like lesions. 14 Disturbance of the liver microcirculation with reduced portovenous or hepatovenous flow may result in a compensatory arterial hyperperfusion, ultimately leading to a nonspecific polyclonal focal hepatocyte proliferation and MRN formation. 2,6,11,15 Some authors have linked all these benign hepatocellular nodules, namely NRH, MRN and FNH, to a common congenital anomaly of the portal tract.…”

“…2,9,17,19 Furthermore, MRN should be differentiated from malignant liver lesions, especially metastases in the case of follow up of oncologic patients. 14,15…”