NorthShore University HealthSystem Hepatic Pancreatic Biliary Conference 10/25/2016 6 Patients

1 Case of previously resected large primary mesenteric mass with liver met followed with adjuvant therapy. The patient experienced new symptoms. Restaging imaging now and during the past 2 years shows a stable recurrent mass and continued stable liver met.  Recommendation: No role for additional treatment at the present time; continued observation.

2 Case of moderately differentiated squamous cell esophageal carcinoma with multiple suspicious areas. The patient underwent radiotherapy plus carbotaxal, and recent imaging and endoscopy with biopsy show no tumors but only Barrett’s without dysplasia.  Recommendation: No role for surgery due to good results of therapy.

3 Case of previously resected colon cancer with liver met followed by adjuvant therapy and re-resection a few months ago for recurrent disease. The patient offers new complaints of severe abdominal pain, and imaging reveals fluid accumulation in addition to a suspicious area at the resection site.  Recommendation: Obtain ERCP and EUS for fluid drainage, cytology and biopsy.

4 Case on list but presenter not available.

5. Case of recently resected T2N0, margin negative, LVI and PNI negative duodenal cancer.  Recommendation: No role for adjuvant treatment based on negative pathology.

6 Case of patient complaint of epigastric and UGI discomfort leading to imaging revealed possible primary cancers: bronchogenic and possible ovarian versus mucinous GI tract cancer.  Recommendation: Refer to interventional gastroenterology for EUS and biopsy of the mediastinum and lymph nodes and possibly Interventional Radiology for lung biopsy.

7 Case of previously resected T2N0 esophageal cancer who failed to undergo adjuvant therapy due to the excellence response of neoadjuvent treatment. Patient now presents with complaints of fatigue and has a rising CEA to 42. Earlier imaging revealed that the patient appeared to be aspirating but current imaging shows a large pancreatic mass with multiple metastatic liver lesions.  Recommendation: Refer to Intervential Radiology for core biopsies of the liver to determine location of the primary.