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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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| Published in: | BMJ case reports 2020-03, Vol.13 (3), p.e232628 |
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| creator | Sarathy, Vinu Kothandath Shankar, Rajesh Kumar Mufti, Suhail Sayeed Naik, Radheshyam |
| description | 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. |
| doi_str_mv | 10.1136/bcr-2019-232628 |
| format | article |
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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.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2019-232628</identifier><identifier>PMID: 32139448</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject><![CDATA[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]]></subject><ispartof>BMJ case reports, 2020-03, Vol.13 (3), p.e232628</ispartof><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2020 BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b456t-1740cc335a2823049f37dfd5eab16afa919565a30fe1fa5f5fccd7f4ed53535c3</citedby><cites>FETCH-LOGICAL-b456t-1740cc335a2823049f37dfd5eab16afa919565a30fe1fa5f5fccd7f4ed53535c3</cites><orcidid>0000-0002-4593-0995</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059495/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059495/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32139448$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sarathy, Vinu</creatorcontrib><creatorcontrib>Kothandath Shankar, Rajesh Kumar</creatorcontrib><creatorcontrib>Mufti, Suhail Sayeed</creatorcontrib><creatorcontrib>Naik, Radheshyam</creatorcontrib><title>FOLFOX and capecitabine-induced hepatic granuloma mimicking metastasis in a rectal cancer patient</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>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.</description><subject>Acids</subject><subject>Antimetabolites, Antineoplastic - administration & dosage</subject><subject>Antimetabolites, Antineoplastic - adverse effects</subject><subject>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</subject><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Biopsy</subject><subject>Cancer therapies</subject><subject>Capecitabine - administration & dosage</subject><subject>Capecitabine - adverse effects</subject><subject>Case reports</subject><subject>Chemical and Drug Induced Liver Injury - etiology</subject><subject>Chemotherapy</subject><subject>Colorectal cancer</subject><subject>Diagnosis, Differential</subject><subject>Fluorouracil - administration & dosage</subject><subject>Fluorouracil - adverse effects</subject><subject>Gastroenterology</subject><subject>Granuloma - chemically induced</subject><subject>Granulomas</subject><subject>Hepatitis</subject><subject>Histopathology</subject><subject>Humans</subject><subject>Injuries</subject><subject>Leucovorin - administration & dosage</subject><subject>Leucovorin - adverse effects</subject><subject>Liver</subject><subject>Liver diseases</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Metabolism</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Organoplatinum Compounds - administration & dosage</subject><subject>Organoplatinum Compounds - adverse effects</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Rectal Neoplasms - drug therapy</subject><subject>Reminder of Important Clinical Lesson</subject><subject>Sarcoidosis</subject><subject>Systemic diseases</subject><subject>Tomography</subject><subject>Tuberculosis</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqFkc1LwzAYh4MoKnNnbxLwJlTz2Y-LIOJUGOyisFt4myZbZpvWtBX8783YFD2ZBBLI8_7eFx6Ezim5ppSnN6UOCSO0SBhnKcsP0CnNZJZkBVke_nqfoGnfb0hcnIpc8GN0whnlhRD5KYLZYj5bLDH4CmvojHYDlM6bxPlq1KbCa9PB4DReBfBj3TaAG9c4_eb8CjdmgD4e12PnMeBg9AB1zPHaBLytM344Q0cW6t5M9_cEvc4eXu6fkvni8fn-bp6UQqZDQjNBtOZcAssZJ6KwPKtsJQ2UNAULBS1kKoETa6gFaaXVusqsMJXkcWs-Qbe73G4sG1Pp2DpArbrgGgifqgWn_v54t1ar9kNlRBaikDHgch8Q2vfR9IPatGPwcWbFeEZpzpgkkbrZUTq0fR-M_elAidpqUVGL2mpROy2x4uL3YD_8t4QIXO2Astn8m_YFk-yXoA</recordid><startdate>20200304</startdate><enddate>20200304</enddate><creator>Sarathy, Vinu</creator><creator>Kothandath Shankar, Rajesh Kumar</creator><creator>Mufti, Suhail Sayeed</creator><creator>Naik, Radheshyam</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4593-0995</orcidid></search><sort><creationdate>20200304</creationdate><title>FOLFOX and capecitabine-induced hepatic granuloma mimicking metastasis in a rectal cancer patient</title><author>Sarathy, Vinu ; Kothandath Shankar, Rajesh Kumar ; Mufti, Suhail Sayeed ; Naik, Radheshyam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b456t-1740cc335a2823049f37dfd5eab16afa919565a30fe1fa5f5fccd7f4ed53535c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acids</topic><topic>Antimetabolites, Antineoplastic - administration & dosage</topic><topic>Antimetabolites, Antineoplastic - adverse effects</topic><topic>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</topic><topic>Antineoplastic Combined Chemotherapy Protocols - adverse effects</topic><topic>Biopsy</topic><topic>Cancer therapies</topic><topic>Capecitabine - administration & dosage</topic><topic>Capecitabine - adverse effects</topic><topic>Case reports</topic><topic>Chemical and Drug Induced Liver Injury - etiology</topic><topic>Chemotherapy</topic><topic>Colorectal cancer</topic><topic>Diagnosis, Differential</topic><topic>Fluorouracil - administration & dosage</topic><topic>Fluorouracil - adverse effects</topic><topic>Gastroenterology</topic><topic>Granuloma - chemically induced</topic><topic>Granulomas</topic><topic>Hepatitis</topic><topic>Histopathology</topic><topic>Humans</topic><topic>Injuries</topic><topic>Leucovorin - administration & dosage</topic><topic>Leucovorin - adverse effects</topic><topic>Liver</topic><topic>Liver diseases</topic><topic>Lymphatic system</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Metabolism</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Organoplatinum Compounds - administration & dosage</topic><topic>Organoplatinum Compounds - adverse effects</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Rectal Neoplasms - drug therapy</topic><topic>Reminder of Important Clinical Lesson</topic><topic>Sarcoidosis</topic><topic>Systemic diseases</topic><topic>Tomography</topic><topic>Tuberculosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sarathy, Vinu</creatorcontrib><creatorcontrib>Kothandath Shankar, Rajesh Kumar</creatorcontrib><creatorcontrib>Mufti, Suhail Sayeed</creatorcontrib><creatorcontrib>Naik, Radheshyam</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health Medical collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sarathy, Vinu</au><au>Kothandath Shankar, Rajesh Kumar</au><au>Mufti, Suhail Sayeed</au><au>Naik, Radheshyam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>FOLFOX and capecitabine-induced hepatic granuloma mimicking metastasis in a rectal cancer patient</atitle><jtitle>BMJ case reports</jtitle><addtitle>BMJ Case Rep</addtitle><date>2020-03-04</date><risdate>2020</risdate><volume>13</volume><issue>3</issue><spage>e232628</spage><pages>e232628-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>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.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>32139448</pmid><doi>10.1136/bcr-2019-232628</doi><orcidid>https://orcid.org/0000-0002-4593-0995</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Open Access: PubMed Central |
| 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 |
| title | FOLFOX and capecitabine-induced hepatic granuloma mimicking metastasis in a rectal cancer patient |
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