Metastatic cecal adenocarcinoma, polycystic liver and kidney

Case contributed by Dr Michael P Hartung

Presentation

Abdominal pain.

Patient Data

Age: 60 years
Gender: Male

Numerous intermediate attenuation masses throughout the liver, with a large conglomerate in the posterior right liver. Also several small cysts, although fewer than the masses. 

Polycystic kidney disease. 

Subtle mass in the cecum with focal wall thickening and enhancement. Small but abnormal cluster of ileocecal lymph nodes with hetergeneous enhancement. 

Circle indicates location of cecal mass.

Case Discussion

Complex case with a very large burden of hepatic metastases, but also superimposed polycystic liver and kidney disease. A GI (and specifically colon) primary should be very high on your differential with this much liver disease. 

You might think that such a large burden of liver metastases should have a correspondingly large primary tumor, but in this case the cecal mass is actually rather subtle, but it is convincing enough as it is thickened/enhancing and there are metastatic ileocolic adenopathy to support it. It is really helpful to run the colon on both axial and coronal planes and carefully look for an abnormal area of narrowing/thickening in these cases. 

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