Hepatomegaly from pancreatic cancer metastasis

A 65-year-old female, was sent to our hospital for weight loss of 8 kg in four months, right abdominal pain and asthenia. Clinical evaluation highlighted a hepatomegaly up to pelvis with hard consistency on palpation. Serum laboratory studies showed the following abnormal values: pancreatic amylase 84 U/L, aspartate aminotransferase 69 U/L, alanine aminotransferase 61 U/L, gamma-glutamyl transferase 214 UI/L, alkaline phosphatase 191 U/L and carbohydrate antigen 19–9104 U/ml. Abdomen Multi-detector computed tomography imaging axial (Fig. 1), coronal MIP and VRT reconstruction (Fig. 2A and B) demonstrated multiple hepatic nodules (arrows) occupying almost all liver parenchyma and a single nodule at the pancreatic tail (arrowhead). US-guided liver biopsy demonstrated the diagnosis of metastatic pancreatic adenocarcinoma. Patient has just started chemotherapy with nabplaclitaxel and gemcitabine, with the aim of reduction of tumour masses and pain relief.

Figure 1.

Contrast-enhanced multi-detector computed tomography axial images that shows multiple hepatic nodules (arrows) and a single nodule at the pancreatic tail (arrowhead).

Figure 2.

(A and B) Contrast-enhanced multi-detector computed tomography coronal MPR (A) and VRT (B) reconstruction that confirm multiple hepatic nodules (arrows) and a huge hepatomegaly up to pelvis.

Liver metastases from pancreatic cancer are present in 37–41.9% of cases already in the first clinical diagnosis.¹ Therefore, an accurate evaluation of possible locoregional and/or distant metastases in patients with pancreatic cancer is crucial, in order to indicate clinical treatment.^1–3

Authors’ contributions

Umberto G. Rossi: write paper, diagnosis, images.

Andrea DeCensi: review paper, treatment.

Funding

The authors declare that there is no funding.

Conflict of interest

The authors declare that there is no conflict of interest.