Pancreatic cancer liver metastasis mimicking focal nodular hyperplasia. A case report

Metastases to the liver from gastroenteropancreatic neuroendocrine tumors are varied in their presentation and echogenicity on ultrasound. We present a case of adenocarcinoma of the pancreas with sporadic neuroendocrine differentiation and metastasis to the liver, referred for inclusion in a clinical study. Standard ultrasound showed two hypoechoic focal liver lesions. On contrast enhanced ultrasound (CEUS) the larger tumour bore an enhancement resemblance to that of a focal nodular hyperplasia (FNH). This result necessitated a histological confirmation, which indicated neuroendocrine, highly differentiated tumour tissue, compatible with metastasis from the patient's pancreatic cancer. This case showcases the role of histologically confirmed diagnosis in liver lesions with atypical imaging characteristics, especially in patients with a history of malignancy and potential oncological treatment.