Table 1 Timeline of care

Prior History

• -9 years: Left ulnar nerve decompression

• -3 years: Roux-en-Y gastric bypass for obesity with resolution of previously untreated Type 2 Diabetes Mellitus

Diagnosis and Interventions

• Anemia, fatigue, left upper quadrant fullness on physical examination, serum hemoglobin 7 mg/dl

• CT scan showed a 24 cm left upper quadrant mass with multiple liver metastases and a single 1 cm spleen metastasis

• Laparoscopic liver biopsy: read as hepatocellular carcinoma vs. hepatoid carcinoma

• +1 month: Serum hemoglobin 4.0 g/dl, surgery for completion gastrectomy, splenectomy, small bowel resection, colon resection, and distal pancreatectomy, complicated by intra-abdominal sepsis treated non-operatively

Follow-up and outcomes

• +8 months: left lateral segmentectomy of the liver, resection of multiple liver nodules

• +20 months: solitary liver lesion treated with percutaneous RFA

• +35 months: multiple liver lesions, open resection with intraoperative RFA

• +52 months: Percutaneous RFA of central liver lesion

• +77 months: Negative octreotide scan, percutaneous RFA of central liver lesion

• +84 months: No evidence of disease, monthly administration of long acting release somatostatin (20 mg) and diabetes mellitus (treated with insulin)