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World J Surg Oncol. 2014 Mar 29;12:75. doi: 10.1186/1477-7819-12-75.

Multiple primary malignancies of the liver and the colon: a complex diagnostic and decisional process with a final unanswered question.

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Department of Medical and Surgical Sciences, Surgical Clinic, Brescia University, III Chirurgia, Spedali Civili di Brescia, P,le Spedali Civili, 1, 25123 Brescia, Italy.


We herein present the case of a 78-year-old man with an incidental finding of a solid hepatic mass without symptoms and only a laparotomic cholecystectomy for acute cholecystitis in the past surgical history. A colonoscopy, a magnetic resonance imaging scan, a positron emission tomography scan, and a computed tomography scan completed the preoperative workup: a neoplastic lesion 4.3×3 cm in size was diagnosed at segments IV and V, associated with a neoplastic involvement of the splenic flexure without signs of colonic occlusion. After colonic resection, a frozen section on a granulomatous-like tissue at gastric border suggested a diagnosis of an adenocarcinoma of bilio-pancreatic type, changing the surgical strategy to include gastric resection and hepatic pedicle node dissection. The discussion turns around the idea that a final diagnosis of colon cancer with regional nodal involvement (pT3N1) and metastatic gallbladder cancer with multiple peritoneal seedings cannot be excluded.

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