title: Multiple primary malignancies of the liver and the colon: a complex diagnostic and decisional process with a final unanswered question.
abstract: We herein present the case of a 78-year-old man with an incidental finding of a solid hepatic mass without symptoms and only a laparotomic cholecystectomy for acute cholecystitis in the past surgical history. A colonoscopy, a magnetic resonance imaging scan, a positron emission tomography scan, and a computed tomography scan completed the preoperative workup: a neoplastic lesion 4.3×3 cm in size was diagnosed at segments IV and V, associated with a neoplastic involvement of the splenic flexure without signs of colonic occlusion. After colonic resection, a frozen section on a granulomatous-like tissue at gastric border suggested a diagnosis of an adenocarcinoma of bilio-pancreatic type, changing the surgical strategy to include gastric resection and hepatic pedicle node dissection. The discussion turns around the idea that a final diagnosis of colon cancer with regional nodal involvement (pT3N1) and metastatic gallbladder cancer with multiple peritoneal seedings cannot be excluded.
authors.affiliation: Department of Medical and Surgical Sciences, Surgical Clinic, Brescia University, III Chirurgia, Spedali Civili di Brescia, P,le Spedali Civili, 1, 25123 Brescia, Italy. portolan@med.unibs.it.
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Gianluca
authors.initials: G
authors.lastname: Baiocchi
authors.forename: Carla
authors.initials: C
authors.lastname: Baronchelli
authors.forename: Federico
authors.initials: F
authors.lastname: Gheza
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Giulini
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D003113:Colonoscopy; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000601:surgery; D011379:Prognosis; D014057:Tomography, X-Ray Computed