Hepatic abscess in cancer patients. Characterization and management
S. G. Marcus, T. J. Walsh, P. A. Pizzo and D. N. Danforth Jr
Surgery Branch, National Cancer Institute, Bethesda, Md.
OBJECTIVE: To identify factors that may aid in the diagnosis and treatment
of patients with malignant neoplasms in whom hepatic abscesses develop.
DESIGN: Retrospective review of medical records. PATIENTS: Thirty-seven
oncology patients in whom hepatic abscesses developed at the National
Cancer Institute, Bethesda, Md, between June 1954 and October 1989.
RESULTS: Among 37 cancer patients, bacterial abscesses developed in 17 and
fungal abscesses developed in 20. Among the patients with bacterial
abscesses, 12 (71%) had a solid-tissue malignant neoplasm, 10 (59%) had a
prior invasive procedure, and six (35%) had prior chemotherapy. In
comparison, among the patients with fungal abscesses, 15 (75%) had a
hematologic malignant neoplasm and five (25%) had a solid-tissue malignant
neoplasm (P2 = .014). Two patients with fungal abscesses (10%) had a prior
invasive procedure (P2 = .004) and 19 (95%) had prior chemotherapy (P2 <
.0001). As compared with fungal abscesses, bacterial abscesses were larger
(P2 < .00001) and fewer (P2 = .004). Antibiotics and percutaneous or
surgical drainage effectively treated bacterial abscesses. Amphotericin B
usually eradicated hepatic fungal infections. CONCLUSIONS: The results of
this study reveal the importance of the clinical setting in the diagnosis
of hepatic abscesses in cancer patients. Aggressive treatment of these
abscesses is indicated and is frequently effective.
