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Liver Abscesses Mimicking Metastatic Disease in a Patient with Pancreatic Cancer Following Neoadjuvant FOLFIRINOX Therapy

Context Based on the results of the ACCORD11/PRODIGE4 Trial, FOLFIRINOX is nowadays increasingly used in a neoadjuvant setting in borderline resectable or locally advanced pancreatic cancer. Case report We report the case of a 59 year old jaundiced patient with a mass in the pancreatic head that was initially judged unresectable by an explorative laparotomy. The patient was referred for FOLFIRINOX chemotherapy. At the time of restaging the patient had developed three liver lesions that were suspicious for liver metastases on both CT and MRI imaging. Ultrasonography guided biopsy revealed no malignancy but positive microbiology suggestive for cholangitis abscesses. This was confirmed by a second explorative laparotomy in which the primary tumor was resected with an uneventful postoperative course. Conclusion Liver abscesses are a known complication of FOLFIRINOX treatment and are sometimes difficult to differentiate from metastases. Therefore, newly developed liver lesions under FOLFIRINOX treatment must be thoroughly analyzed prior to making a decision against surgery. In cases of uncertainty an explorative laparotomy/laparoscopy must be considered.

Author(s): Jan G D´Haese, Christoph W Michalski, Konstantin Holzapfel, Jörg Kleeff

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