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 oxaliplatin-based 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.

Keywords: Focal nodular hyperplasia, Colorectal cancer, Colorectal liver metastasis, Oxaliplatin, Systemic chemotherapy

Core tip: This report describes two interesting cases of patients who developed multiple focal nodular hyperplasias during oxaliplatin-based therapy for colorectal cancer. Such multiple bilateral focal liver lesions were misdiagnosed as colorectal liver metastases, and treated with liver resection. A review of the cases revealed that in both cases the fluorodeoxyglucose-positron emission tomography was negative. A brief review of the literature together with the authors’ comments is included.