Calcified liver metastases: a specific roentgen diagnostic sign.

Abstract

Calcification is found infrequently in metastatic tumors. In hepatic metastases particularly it is generally considered as of rare occurrence, though the liver is a common site of secondary neoplastic growth. We have been able to find reports of only 8 cases in the literature (1–5). Experience has convinced us that the radiographic picture to be described herein is of practical value in the recognition of certain metastatic neoplasms in the liver, yielding a relatively specific diagnosis of tumor derived from the large bowel. Antemortem Radiographic Identification of Calcified Liver Metastases Within the last three years, one of us (A. J. M.) encountered 4 cases in which evidence of calcified liver metastases appeared in radiographs of the abdomen. In 3 of these, subsequent biopsy or autopsy confirmed the diagnosis. In each instance, the primary site of the neoplasm was in the large bowel. Case Reports Case I: W. D., a female forty-seven years old, was admitted to the medical service of the Norfolk General Hospital on May 24, 1959, because of quadriplegia of recent onset. Her illness, of one year duration, was characterized by anorexia, indigestion, weight loss, and severe mental depression. There was no history of change in bowel habits or of rectal bleeding. Previous hospitalization elsewhere, in 1959, had failed to yield a diagnosis. The family and past history were noncontributory. Significant physical findings were: hard bilateral cervical lymph nodes, hepatomegaly of 4 fingerbreadths, quadriplegia, and brown stool in the rectum. Laboratory findings were as follows: hemoglobin, 11.9 gm.; hematocrit, 39.0; white blood cells, 18,300. Cephalin flocculation was negative, thymol turbidity was normal, and the icteric index was 4. Alkaline phosphatase was 52 units (normal 2–5), and total serum proteins 5.5 gm. per cent. Upper gastrointestinal x-ray examination was interpreted as negative. A single calcified gallstone was demonstrated. Calcifications in the right upper quadrant (Fig. 1, coned) were noted but not recognized as liver metastases. Liver biopsy was reported as showing “metastatic adenocarcinoma, probably of gastrointestinal origin” (R. Shuman, pathologist). The patient died on the twenty-first hospital day. Postmortem examination revealed a flat primary adenocarcinoma measuring 4.0 × 2.0 cm., situated on the posterior wall of the cecum with metastases in the liver, cervical lymph nodes, and spinal cord. The calcifications previously demonstrated on the radiograph were found to lie within the large metastases in the liver. Case II: J. K., a female seventy years of age, was admitted to the medical service of the Washington Hospital Center, Sept. 27, 1960, because of jaundice, weakness, and weight loss. In 1955, an adenocarcinoma of the sigmoid colon had been resected. A right nephrectomy had been performed in 1959 for retroperitoneal metastasis, and treatment with ThioTEPA had been initiated the same year.