Digestive Diseases and Sciences, Vol. 50, No. 2 (February 2005), pp. 345–347 ( C  2005) DOI: 10.1007/s10620-005-1608-y CASE REPORT Late-Occurring Liver Metastases in Colorectal Cancer FRANCISCO RODR ´ IGUEZ -MORANTA , MD,* ANTONI CASTELLS , MD,* ROSA MIQUEL , MD,† VIRGINIA PI ˜ NOL , MD,* JOAN MAUREL , MD,‡ JOSEP FUSTER , MD,§ ANTONIO M. LACY , MD,§ and JOSEP M. PIQU ´ E , MD* KEY WORDS: colorectal cancer metastases; late recurrence; follow-up. Follow-up programs for patients with resected colon can- cer are directed to identifying asymptomatic recurrences, either locoregional or distant, at a stage early enough to al- low curative reoperation. However, the nature, frequency, and duration of the follow-up are under discussion (1). Most follow-up programs end 5 years after primary treat- ment (2, 3). Nevertheless, it has been suggested that the interval until recurrence for rectal cancer could be longer than for colon cancer. In that sense, there are some cases reporting tumor relapse of rectal cancer more than 10 years after curative resection (4), thus suggesting that these pa- tients should be followed for a longer period of time. On the contrary, colon cancer recurrence generally appears during the first 5 years after curative resection, although there is some evidence that left-sided large bowel cancers have a slowly progressive natural history (5). We present a patient with colon cancer who devel- oped liver metastases 12 years after treatment of primary neoplasm. CASE REPORT A 41-year-old woman was diagnosed with colon cancer lo- cated in the descendent colon in March 1991 as a result of study of anemia. Left hemicolectomy was performed as the pri- mary treatment. Pathological study revealed an intestinal mod- erately differentiated adenocarcinoma with infiltration into the muscularis propria, without lymph node involvement (tumor stage T2N0M0). The patient did not receive chemotherapy. Af- ter discharge, she was followed up with regular clinical controls, laboratory testing, imaging techniques, and endoscopy. The last Manuscript received June 9, 2004; accepted August 12, 2004. From the *Gastroenterology and §Surgery Departments, Institut de Malalties Digestives, and †Pathology and ‡Oncology Departments, Hos- pital Cl´ ınic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain. Address for reprint requests: Dr. Antoni Castells, Gastroenterology Department, Institut de Malalties Digestives, Hospital Cl´ ınic, Villarroel 170, 08036 Barcelona, Catalonia, Spain; castells@clinic.ub.es. colonoscopy was done in June 2001, along with blood testing (complete blood cell count, liver function, serum carcinoembry- onic antigen [CEA] concentration) and liver ultrasound. None of these examinations detected any abnormality. In February 2003, a routine blood test performed for an unre- lated condition detected an increase in γ -glutamyltranspeptidase (84 IU/L) and alkaline phosphatase (435 IU/L) concentrations. Subsequent analysis demonstrated an increase in serum CEA concentration (200 ng/ml), whereas an abdominal CT scan iden- tified an 8 × 11-cm mass occupying hepatic segments V and VI. No other abdominal lesion was observed. With a suspected diagnosis of liver metastases, a fine-needle aspiration biopsy was performed. Cytological study confirmed a moderately differ- entiated adenocarcinoma of putative intestinal origin. Immuno- cytochemical analysis revealed expression of cytokeratin 20 in approximately 60% of cells (Figure 1A) and absence of cytoker- atin 7 and p53 expression. Upper endoscopy, colonoscopy, small bowel follow-through series, and thoracic–abdominal CT did not identify a synchronous primary neoplasm. In order to confirm the metastatic origin of the hepatic mass, immunohistochemical analysis was performed in the primary colon cancer, resulting in an identical pattern (Figure 1B). The patient was treated by means of neoadjuvant chemother- apy (oxaliplatin, 5-fluorouracil, and leucovorin) and right portal vein embolization, followed by right hepatectomy. Surgical ex- amination did not identify any additional metastasis or other primary neoplasm. Pathological study confirmed the presence of a metastatic intestinal adenocarcinoma with the cytokeratin pattern previously described. DISCUSSION In the current report, a metastatic origin of the liver mass was assumed on the basis of an identical cytokeratin pattern in both the primary colon tumor and the distant le- sion, along with the absence of any other potential primary neoplasia. Late liver metastastic spread of colorectal cancer af- ter 5 years of follow-up is very uncommon, and in fact, no metastases have been reported more than 10 years after radical resection of primary tumor. Sadahiro and coworkers (6) studied recurrence patterns in patients Digestive Diseases and Sciences, Vol. 50, No. 2 (February 2005) 345 0163-2116/05/0200-0345/0 C  2005 Springer Science+Business Media, Inc.