FOLFOX and capecitabine-induced hepatic granuloma mimicking metastasis in a rectal cancer patient

A 49-year-old male carcinoma rectum patient was treated with neoadjuvant FOLFOX (folinic acid, fluorouracil (5-FU) and oxaliplatin) chemotherapy, chemoradiotherapy with capecitabine, surgery and adjuvant FOLFOX. On follow-up, the patient developed a metabolically active liver lesion mimicking metast...

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Bibliographic Details
Published in:BMJ case reports 2020-03, Vol.13 (3), p.e232628
Main Authors: Sarathy, Vinu, Kothandath Shankar, Rajesh Kumar, Mufti, Suhail Sayeed, Naik, Radheshyam
Format: Article
Language:English
Subjects:
Acids
Antimetabolites, Antineoplastic - administration & dosage
Antimetabolites, Antineoplastic - adverse effects
Antineoplastic Combined Chemotherapy Protocols - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Biopsy
Cancer therapies
Capecitabine - administration & dosage
Capecitabine - adverse effects
Case reports
Chemical and Drug Induced Liver Injury - etiology
Chemotherapy
Colorectal cancer
Diagnosis, Differential
Fluorouracil - administration & dosage
Fluorouracil - adverse effects
Gastroenterology
Granuloma - chemically induced
Granulomas
Hepatitis
Histopathology
Humans
Injuries
Leucovorin - administration & dosage
Leucovorin - adverse effects
Liver
Liver diseases
Lymphatic system
Male
Medical imaging
Metabolism
Metastasis
Middle Aged
Mortality
Organoplatinum Compounds - administration & dosage
Organoplatinum Compounds - adverse effects
Ostomy
Patients
Rectal Neoplasms - drug therapy
Reminder of Important Clinical Lesson
Sarcoidosis
Systemic diseases
Tomography
Tuberculosis
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Summary:A 49-year-old male carcinoma rectum patient was treated with neoadjuvant FOLFOX (folinic acid, fluorouracil (5-FU) and oxaliplatin) chemotherapy, chemoradiotherapy with capecitabine, surgery and adjuvant FOLFOX. On follow-up, the patient developed a metabolically active liver lesion mimicking metastasis. Liver biopsy and histopathology showed sinusoidal dilatation with non-caseating granulomas. Follow-up fluorodeoxyglucose positron-emission tomography CT scan demonstrated increase in size of the lesion with metabolic activity suspicious of metastasis. The patient underwent segmental liver resection and histopathology showed non-necrotising granuloma with no evidence of malignancy. It is crucial to consider potential side effects of chemotherapeutic agents and have an unbiased approach when evaluating new liver lesions during post treatment follow-up of colorectal cancer. A multidisciplinary tumour board approach comprising of gastroenterologists, medical oncologists, pathologists, radiologists and surgeons is suggested in the management of such patients. The patient is currently doing well and on regular follow-up.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-232628