Misdiagnosis of metastatic liver cancer as liver abscess: clinical analysis of 4 cases

Abstract

Objective To investigate the causes, diagnosis, treatment and prognosis of misdiagnosing metastatic liver cancer as liver abscess. Methods Clinical data of 4 patients with metastatic liver cancer misdiagnosed as liver abscess in Department of General Surgery, the Third Hospital of Shenzhen from April 2012 to April 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the ethics committee approval was received. There were 1 male and 3 females with age ranging from 44 to 67 years old and a median age of 54 years old. All the patients received tests such as blood routine, liver function, alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and so on, and examinations of hepatobiliary ultrasonography, computed tomography (CT) scan of the upper abdomen, gastroscope and colonoscope after admission to hospital. Results The mean temperature of patients was (37.8±0.8)℃ when admitted in hospital. Two cases got fever and shivering, and 4 cases suffered upper abdominal pain or discomfort. There were 2 cases with increasing white blood cell (WBC) and increasing alkaline phosphatase (ALP), 3 cases with increasing CA19-9, 2 cases with increasing CEA and 1 case with increasing AFP. By ultrasound examination and CT , multiple lesions were observed in 3 cases and single lesion in 1 case, including 2 cases of cystic lesions. Obvious edge enhancement was found in 3 cases by CT scan, heterogeneous internal enhancement in 2 cases, no internal enhancement in 2 cases, and 3 cases were found with lymphadenectasis in the porta hepatis or retroperitoneum. By pathological examination, 2 cases were diagnosed with liver metastasis of colon cancer, 1 case with liver metastasis of gastric cancer. And 1 case was clinically diagnosed with liver metastasis of gastrointestinal tract or extrahepatic bile duct cancer. Two cases received anti-infection treatment after admission to hospital. One case received liver tumor biopsy + catheter drainage of liquefied necrotic tissues, and 1 case received colon cancer resection for intestinal obstruction. All the 4 patients received chemotherapy. One case died of multiple organ failure 3 months after being diagnosed and 1 case who had undergone colon cancer resection still received chemotherapy and lived well till the date of paper submission. The other 2 cases were in poor condition. Conclusions Some patients with metastatic liver cancer are usually misdiagnosed as liver abscess because of the untypical clinical features. The tumor marker detection is helpful for the differential diagnosis. Comprehensive treatments with the main of surgical resection should be employed in the patients but the prognosis is poor. Key words: Liver neoplasms; Neoplasm metastasis; Liver abscess; Diagnostic errors