Oxaliplatin-Induced Multiple Focal Nodular Hyperplasia Masquerading as Colorectal Liver Metastasis—Case Report and Review of Literature
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Focal nodular hyperplasia (FNH) is a benign condition with the prevalence of around 2.6% in autopsy studies [1, 2]. Pathophysiology of FNH is poorly understood with intrahepatic blood flow distortion being one of the most plausible theories .
Oxaliplatin causes vascular injury in the form of sinusoidal dilatation with erythrocyte extravasation leading to sinusoidal obstruction syndrome (SOS) or blue liver. Extreme form of vascular injury leads to regenerative nodular hyperplasia also known as FNH.
SOS usually presents as reticular hyperintensity on hepatobiliary phase of gadoxetic acid–enhanced magnetic resonance images (EOB-MRI), but does not usually present with focal lesions . Very few case reports are there in literature where patients have presented with liver lesion post oxaliplatin-based chemotherapy. We present a case of a rectal cancer patient who after surgery and oxaliplatin-based chemotherapy presented with liver lesions masquerading as liver metastasis.
Chirag Jain prepared the first draft of the paper.
Asif Syed collected all the images and follow up of the patient for compiling the manuscript.
Nikhil Gupta contributed in the clinical management of the patient and also in correcting the draft of the manuscript.
Meenakshi Kambhoj prepared the pathology manuscript of the patient in the study.
Avinash Rao finalized the radiological findings and contributed significantly in the preparation of the manuscript.
Shivendra Singh finalized the manuscript and contributed significantly in editing the manuscript.
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Conflict of Interest
The authors declare that there are no conflicts of interest.
- 3.Rubbia-Brandt L, Lauwers GY, Wang H, Majno PE, Tanabe K, Zhu AX, et al. Sinusoidal obstruction syndrome and nodular regenerative hyperplasia are frequent oxaliplatin-associated liver lesions and partially prevented by bevacizumab in patients with hepatic colorectal metastasis. Histopathology. 2010;56:430–9.CrossRefGoogle Scholar