Hepar lobatum carcinomatosum associated with metastatic rectal carcinoma: an unusual cause of liver dysmorphy

The aim of this study was to present a case of hepar lobatum resulting from metastatic rectal carcinoma. A 50-year-old man presented with a 2-year history of bleeding per anum, tenesmus, malaise and weakness. Initially, the patient received neoadjuvant chemoradiotherapy followed by abdominoperineal resection of the rectum. Abdominal computed tomography showed lobar enlargement and lobulated contour, mainly in the left lobe of the liver, but no primary or metastatic lesions were detected. Laparotomy revealed an irregularly lobulated hepatic deformity. Liver biopsy showed a necrotic tumor growth from adenocarcinoma of the rectum in subcapsular localizationof the liver. This case showed a patient with hepar lobatum carcinomatosum caused by metastatic rectal carcinoma. The report further highlights the need for clinicians and surgeons to keep in mind the possibility of hepar lobatum carcinomatosum while caring for rectal carcinoma patients, especially when the lobulated contour of the liver is detected at preoperative imaging studies or when the coarsely lobated liver is encountered during surgery for carcinoma of the rectum

Development of two cancers in the same patient after ileorectal and ileal pouch anal anastomosis for familial adenomatous polyposis

To report a case of a patient with familial adenomatous polyposis. A 36-year-old male patient who suffered from rectal bleeding was treated with colectomy and ileorectal anastomosis for familial adenomatous polyposis [FAR] in 1974. After 19 years, in situ adenocarcinoma was detected in the rectal stump. Completion proctectomy, mucosectomy, and hand-sewn ileal pouch anal anastomosis with protective ileostomy were performed. In 2002, a metachronous cancer was detected at the anastomosis and abdominoperineal resection of the pouch and end ileostomy were performed. Later on, the perineum was excised locally because of cancer recurrence. This case shows that lifetime surveillance of the FAR patients after surgery is crucial