Diffuse Avid Uptake in the Liver

Vikas Dembla, MD 

July 13, 2016

A 67 year old man with history of squamous cell carcinoma of the skin on the forehead (treated with local excision) and history of prostate adenocarcinoma in 2006 treated with radical prostatectomy was referred to the oncology clinic after surveillance CT scans revealed new lesions in bilateral hepatic lobes. Physical examination did not reveal any icterus, pallor or hepato-splenomegaly. Initial liver function tests were within normal limits. Pet/CT confirmed the hepatic lesions (Figure 1) and also showed extensive lesions in the bones, left adrenal gland, retroperitoneal and the right common iliac lymph nodes. The PET/CT did not identify a primary tumor. There were no brain metastases evident on CT scan of the head. 

Biopsy of one of the liver lesions showed poorly differentiated adenocarcinoma with neuroendocrine features. Immunostaining was positive for synaptophysin, carcinoembryonic antigen (CEA), and CK 7. Serum Chromogranin A and 24 hour urine HIAA were within normal limits. Serum CEA and CA 19-9 were elevated, whereas serum alpha-fetoprotein and PSA were within normal limits, and testosterone adequately suppressed. 

Due to increasing fragility, acute kidney injury and rapidly declining performance status, the patient declined further work up and opted for hospice care. 

Figure 1

Figure 2

Biography: Vikas Dembla, MD is a staff Hematologist-Oncologist at the Overton Brooks VA Medical Center in Shreveport, Louisiana since 2010 with a special interest in treating Colo-Rectal cancers and Head and Neck cancers.