Metachronous colorectal liver metastasis that occurred 10 years after laparoscopic colectomy: a case report

Abstract

Background: Delayed onset of colorectal liver metastasis (CRLM) > 5 years after primary colorectal surgery is rare. Herein, we report a case of delayed-onset CRLM that occurred 10 years after primary surgery, for which laparoscopic hepatectomy was performed.

Case presentation: A 68-year-old man was admitted to the hospital. His medical history revealed double colon cancer detected 10 years ago, for which laparoscopic colectomy was performed. The pathological tumor-node-metastasis stages were stages I and II. Thereafter, oral floor cancer occurred 7 years after the primary surgery and was curatively resected. The annual follow-up with positron emission tomography-computed tomography (CT) identified a tumor at segment 7/8 (S7/8) of the liver with an abnormal accumulation of fluorodeoxyglucose. Dynamic CT showed a 23-mm tumor, with ring enhancement in the early phase. Magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid demonstrated that the tumor had high intensity in T2 weighted sequences and low intensity in the hepatobiliary phase. With a preoperative diagnosis of intrahepatic cholangiocarcinoma or delayed liver metastasis, laparoscopic S7/8 partial resection was performed. The operative time was 324 min, and the intraoperative bleeding volume was 35 mL. The patient was discharged on day 15 without any postoperative complications. Upon histopathological examination, the final diagnosis was CRLM. The patient has survived for 1 year without any recurrence.

Conclusions: It is important to pay attention to the occurrence of delayed-metachronous CRLM.

Keywords: Colorectal liver metastasis; Delayed onset; Metachronous.

Fig. 1

Positron emission tomography–computed tomography shows a tumor with abnormal accumulation of fluorodeoxyglucose at liver S7/8

Fig. 2

A, B Abdominal contrast-enhanced computed tomography shows a tumor measuring 23 mm in size with ring enhancement in the early phase (arrow). The tumor shows hypointensity in the delayed phase (arrow)

Fig. 3

A, B Gadolinium–ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced magnetic resonance imaging showing a tumor as a hyperintense lesion without central filling on the T2-weighted image (arrow) and a hypointense lesion in the hepatobiliary phase (arrow)

Fig. 4

Histological examination reveals tall columnar tumor cells forming small glandular duct structures. The pathological diagnosis is moderately differentiated tubular adenocarcinoma (hematoxylin and eosin staining, ×10)

Fig. 5

A–C Immunohistochemical analysis revealed that the tumor was positive for caudal-type homeobox protein 2 and negative for CK7 and CK20. (Staining, ×10)