title: Oxaliplatin toxicity presenting as a liver nodule - case report.
abstract: BACKGROUND
  Oxaliplatin based chemotherapy is often used as adjuvant therapy in colon and rectal cancer. A reported side effect is Sinusoidal Obstruction Syndrome which is characterized by a spectrum of pathologic changes, from sinusoidal dilation, peri-sinusoidal haemorrhage, peliosis and nodular regenerative hyperplasia. Very rarely it can cause the development of liver nodules mimicking liver metastases. Herein, we report a case of Sinusoidal Obstruction Syndrome causing a liver nodule suspicious of liver metastasis on imaging. This is the third reported case of this complication of oxaliplatin toxicity, in which resection was performed and pathological diagnosis confirmed.
  
  
  METHODS
  We report the case of a 59 year old man with stage III colon cancer who underwent sigmoidectomy followed by adjuvant chemotherapy with oxaliplatin. One year after surgery a liver nodule was detected and the patient underwent right hepatectomy. Pathology showed no liver nodule and diagnosed sinusoidal obstruction syndrome.
  
  
  CONCLUSIONS
  We describe the third reported case of a liver lesion mimicking a liver metastasis after oxaliplatin-based chemotherapy for colon cancer. We suggest that in patients heavily treated with oxaliplatin with de novo liver nodules, this differential diagnosis should be considered. In particular, in this population of patients an intense imagiologic evaluation and even a preoperative biopsy should be pursued to confirm the diagnosis of malignancy and avoid overtreatment.
authors.affiliation: Department of General Surgery, Coimbra University Hospital, Coimbra, Portugal. halexandrino123@gmail.com.|Faculty of Medicine, University of Coimbra, Coimbra, Portugal. halexandrino123@gmail.com.
authors.forename: Henrique
authors.initials: H
authors.lastname: Alexandrino
authors.affiliation: Department of Pathology, Oncology Institute, Coimbra, Portugal. domingos.mg.oliveira@gmail.com.
authors.forename: Domingos
authors.initials: D
authors.lastname: Oliveira
authors.affiliation: Department of Pathology, Coimbra University Hospital, Coimbra, Portugal. augustacipriano@gmail.com.
authors.forename: Maria Augusta
authors.initials: MA
authors.lastname: Cipriano
authors.affiliation: Department of General Surgery, Coimbra University Hospital, Coimbra, Portugal. luisferreira82@gmail.com.
authors.forename: Luís
authors.initials: L
authors.lastname: Ferreira
authors.affiliation: Department of General Surgery, Coimbra University Hospital, Coimbra, Portugal. jglrt@gmail.com.|Faculty of Medicine, University of Coimbra, Coimbra, Portugal. jglrt@gmail.com.
authors.forename: J Guilherme
authors.initials: JG
authors.lastname: Tralhão
authors.affiliation: Department of General Surgery, Coimbra University Hospital, Coimbra, Portugal. fcastrosousa@hotmail.com.|Faculty of Medicine, University of Coimbra, Coimbra, Portugal. fcastrosousa@hotmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Castro E Sousa
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D006504:Hepatic Veno-Occlusive Disease / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D000077150:Oxaliplatin; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin