P3729 - Metastatic Colorectal Cancer Masquerading as a Hepatic Hemangioma: A Case Report

Anand Prabhu, MD¹, Dirin Ukwade, MD¹, Omar T. Ahmed, MD², Salimah Mohamed, DO¹, Sandra Naffouj, MD¹, Mary Biglin, MD^1
1University of Illinois College of Medicine, Chicago, IL; ²University of Illinois at Chicago, Chicago, IL

Introduction: Approximately 150,000 Americans are diagnosed with colorectal cancer every year with the rate increasing by 1-2% annually for individuals under the age of 55 (1). The liver is the most common site for metastatic disease and classically presents as multiple hypoechoic liver lesions. This case depicts an unusual presentation of metastatic disease as a large solitary lesion with imaging characteristics consistent with hepatic hemangioma.

Case Description/Methods: A 48-year-old female with history of GERD presented to primary care clinic with right upper quadrant abdominal pain which persisted despite recent eradication of Helicobacter Pylori. She also endorsed a 50-pound unintentional weight loss, early satiety, and new onset alternating constipation and diarrhea over the last two months. Relevant lab investigation revealed Hb 9.5 gm/dl (from Hb 11.9 gm/dl), alkaline phosphatase 146 U/L, AFP 6.9 ng/mL, albumin 3.2 gm/dl, and a negative stool FIT test. Abdominal ultrasound showed a lobulated arch dominant mass within the right lobe measuring 17 x 20 x 15 centimeters (cm), with multiple central cystic areas. Subsequent MRI Abdomen with and without contrast revealed a 19 x 12 x 19 cm right hepatic lobe mass with central necrosis infiltrating the left hepatic lobe. The mass showed peripheral enhancement persisting on post contrast imaging but without central filling given necrosis. This was felt to be a giant cavernous hemangioma. She then underwent a right hepatectomy and partial left lobe resection. Pathology revealed massive multifocal metastatic moderately differentiated colonic adenocarcinoma. A colonoscopy performed afterward demonstrated a partially obstructing mass in the sigmoid colon. Carcinoembryonic antigen was 48.7 ng/ml. PET scan revealed concerns for both osseous metastases and peritoneal carcinomatosis. The patient is currently receiving systemic ipilimumab and nivolumab immunotherapy.

Discussion: This case demonstrates not only an unusual radiologic presentation of metastatic liver disease but underscores the need to maintain a high index of suspicion when laboratory and radiologic findings do not align with clinical presentation. While her stool FIT test and MRI of the abdomen did not show concern for a malignant process, her alarm symptoms suggested otherwise. Thus, it is crucial to recognize the limitations of diagnostics and to assess the overall clinical presentation for prompt diagnosis and treatment.


Disclosures:


Anand Prabhu, MD¹, Dirin Ukwade, MD¹, Omar T. Ahmed, MD², Salimah Mohamed, DO¹, Sandra Naffouj, MD¹, Mary Biglin, MD¹. P3729 - Metastatic Colorectal Cancer Masquerading as a Hepatic Hemangioma: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.