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Characterization and Management

Stuart G. Marcus, MD; Thomas J. Walsh, MD; Philip A. Pizzo, MD; David N. Danforth, Jr, MD

Arch Surg. 1993;128(12):1358-1364.

Abstract
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 clincial setting in the diagnosis of hepatic abscesses in cancer patients. Aggressive treatment of these abscesses is indicated and is frequently effective.

(Arch Surg. 1993;128:1358-1364)

Author Affiliations
From the Surgery Branch (Drs Marcus and Danforth) and the Infectious Disease Section, Pediatric Branch (Drs Walsh and Pizzo), National Cancer Institute, Bethesda, Md.

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