Characteristic radiological findings indicating the possible involvement of the hepatic hilar lymph nodes in patients with colorectal liver metastasis: Case report

• Published in: International journal of surgery case reports Vol. 72; pp. 10 - 16
• Main Authors: Kawasaki, Yota, Iino, Satoshi, Idichi, Tetsuya, Ueno, Shinichi, Natsugoe, Shoji
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2020; Elsevier
• Subjects: Colorectal cancer liver metastasis; Hepatic hilar lymph node involvement; LNs; CT; CRCLM; S; MRI; SUV; DWI; Colorectal cancer liver metastasis; Hepatic hilar lymph node involvement; PET
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.05.040

•Detection of colorectal cancer liver metastasis (CRCLM) with the infiltration of lymph nodes (LNs) in the hepatic pedicle is not so simple.•When detecting tumor progression from CRCLM along with Glisson branch, the possibility of hepatic hilar LNs involvement should be considered.•Surgical approach against CRCLM with hepatic hilar LNs involvement is controversial, but could be acceptable. Colorectal cancer liver metastasis (CRCLM) concomitant with infiltration of lymph nodes (LNs) in the hepatic pedicle is difficult to manage, and is regarded as an extrahepatic metastasis; undertaking hepatectomy is controversial in such a scenario. Case 1, A 55-year-old woman was diagnosed with multiple liver metastases arising from rectal cancer along with enlargement of a retropancreatic LN. A characteristic image prior to hepatectomy demonstrated evident tumor progression from a metastatic lesion in segment 5 of the liver (S5) to the hepatic hilum along with Glisson 5. Post-operative histopathological examination revealed viable adenocarcinoma cancer cells originating from rectal cancer in all the liver metastatic lesions and retropancreatic LN. Case 2, A 89-year-old woman was diagnosed with transverse colon cancer with multiple liver metastases. Radiological examination before hepatectomy revealed tumor progression from a metastatic lesion in the segment 6 of the liver (S6) to the hepatic hilum along with Glisson 6 and LN involvement in the hepatoduodenal ligament. Post-operative histopathological examination demonstrated adenocarcinoma cancer cells in the liver metastatic lesions and in a hepatoduodenal LN. When encountering tumor progression from liver metastatic lesions to hepatic hilum along with its Glisson branch, the possibility of hepatic hilar LN involvement should be considered. Indeed, the surgical management of CRCLM with hepatic hilar LN involvement is controversial, but could be acceptable if the positive LNs are limited to the hepatic pedicle and retropancreatic area.