A Case of Focal Hepatic Sinusoidal Obstruction Mimicking Colorectal Liver Metastases

Abstract

Introduction: Oxaliplatin is a platinum-based antineoplastic agent, and it is common for the treatment of colorectal cancer. Oxaliplatin-induced hepatic sinusoidal obstruction syndrome (HSOS) has been reported, and it may present as reticular hypointensity on hepatobiliary phase images of gadoxetic acid-enhanced magnetic resonance images (EOB-MRI). We experienced that HSOS presented focal lesions, and we could not distinguished between HSOS and metastatic lesion in the liver. Method: A case report. Result: A 51-year old female underwent high anterior resection for rectal cancer, and the pathological diagnosis was advanced rectal cancer, pT4aN2aM0 pStageIIIc. The patient received six cycles of oxaliplatin-based chemotherapy with capecitabine as postoperative adjuvant chemotherapy. Eight months after the operation, the contrast enhanced computed tomography revealed two low density lesions in the liver. The hepatobiliary phase of the EOB-MRI demonstrated three lesions in the liver as hypointense tumors relative to the surrounding hepatic parenchyma. These findings of the preoperative images were compatible to metastatic liver tumors from the rectal cancer, and we performed limited resection of the liver. Histopathological findings of three lesions which were recognized preoperatively revealed that sinusoid within lobules dilated and space of Disse bled. It indicated sinusoidal obstruction injury. There was no malignant lesion. The patient recovered completely and discharged from our hospital on 7th postoperative day. Conclusions: Focal HSOS mimicking metastatic liver tumors is very rare, and it is difficult to discriminate between focal HSOS and liver metastases in the patients who undergo oxaliplatin-based chemotherapy.