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Case report
FOLFOX and capecitabine-induced hepatic granuloma mimicking metastasis in a rectal cancer patient
  1. Vinu Sarathy1,
  2. Rajesh Kumar Kothandath Shankar2,
  3. Suhail Sayeed Mufti2 and
  4. Radheshyam Naik1
  1. 1Medical Oncology, HealthCare Global Enterprises Ltd, Bangalore, India
  2. 2Translational Medicine and Therapeutics, HealthCare Global Enterprises Ltd, Bangalore, India
  1. Correspondence to Dr Vinu Sarathy; sarathy.vinu.88{at}


A 49-year-old male carcinoma rectum patient was treated with neoadjuvant FOLFOX (folinic acid, fluorouracil (5-FU) and oxaliplatin) chemotherapy, chemoradiotherapy with capecitabine, surgery and adjuvant FOLFOX. On follow-up, the patient developed a metabolically active liver lesion mimicking metastasis. Liver biopsy and histopathology showed sinusoidal dilatation with non-caseating granulomas. Follow-up fluorodeoxyglucose positron-emission tomography CT scan demonstrated increase in size of the lesion with metabolic activity suspicious of metastasis. The patient underwent segmental liver resection and histopathology showed non-necrotising granuloma with no evidence of malignancy. It is crucial to consider potential side effects of chemotherapeutic agents and have an unbiased approach when evaluating new liver lesions during post treatment follow-up of colorectal cancer. A multidisciplinary tumour board approach comprising of gastroenterologists, medical oncologists, pathologists, radiologists and surgeons is suggested in the management of such patients. The patient is currently doing well and on regular follow-up.

  • colon cancer
  • chemotherapy
  • liver disease
  • radiology
  • pathology
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  • Contributors VS contributed to case data collection and case write-up. SSM contributed to pathological reporting and case data review. RKKS contributed to literature review. RN contributed to supervision and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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