Abstract
BackgroundPortal vein tumor thrombosis from colorectal cancer is rare, and this recurrence pattern was mainly reported in patients with renal cell carcinoma and hepatocellular carcinoma. Furthermore, the recurrence pattern of portal vein tumor thrombosis without liver parenchymal invasion from colorectal carcinoma has not been previously reported. Herein, we present a patient with progressive portal vein tumor thrombosis without liver parenchymal invasion following curative resection.Case presentationA 61-year-old man with a chief complaint of constipation with abdominal pain associated with rectal carcinoma was admitted to our hospital. Computed tomography (CT) showed that the rectosigmoid colon wall was thickened, regional lymph nodes were swollen, and the light space-occupying lesion (SOL) was detected at segment 8 (S8). Neoadjuvant chemotherapy was performed, which was followed by laparoscopic anterior resection. The final diagnosis was stage IIIb (SS, N2, M0). After operation, systemic adjuvant chemotherapy was introduced. At first, tumor marker levels were within the normal range and there were no accumulations on positron emission tomography (PET). Tumor marker levels were elevated, and contrast-enhanced CT demonstrated that the portal vein SOL slowly extended from S8 to S5. Additionally, PET showed that the standardized uptake value was abnormally high at 5.8. Based on the diagnosis of portal vein tumor thrombosis, right hepatectomy was performed. On pathological analysis, tumor thrombosis was associated with rectal carcinoma, and there was no invasion toward the liver parenchyma. Additionally, the surgical cut end was tumor free. Six months after the hepatectomy, the paraaortic lymph nodes showed swelling. The patient is currently undergoing systemic chemotherapy.ConclusionAggressive surgical resection should be considered in cases of portal vein tumor thrombosis. A good long-term prognosis could be obtained by a combination of curative resection and systemic chemotherapy.
Highlights
Portal vein tumor thrombosis from colorectal cancer is rare, and this recurrence pattern was mainly reported in patients with renal cell carcinoma and hepatocellular carcinoma
Prior treatment with systemic chemotherapy was performed for curative surgery with suspicion of portal vein tumor thrombosis (PVTT): 6 courses of mFOLFOX6 + panitumumab chemotherapy were administered
The primary rectal carcinoma itself did not show massive venous (v1) and lymphatic invasion; even after systemic chemotherapy, PVTT could have occurred through this vascular invasion, or circulating tumor cells (CTCs) may have been implanted into the portal vein wall
Summary
Hepatectomy for resectable liver metastasis from colorectal cancer is the gold standard treatment approach [1,2,3]. Computed tomography (CT) showed that the rectosigmoid colon wall was thickened, regional lymph nodes were swollen, and the obscure space-occupying lesion (SOL) was detected at S8, especially localized into the portal vein. He was admitted to our hospital for further treatment. Prior treatment with systemic chemotherapy was performed for curative surgery with suspicion of PVTT: 6 courses of mFOLFOX6 + panitumumab chemotherapy (panitumumab was administered as a 60-min intravenous infusion before oxaliplatine at a dose of 6 mg/kg, leucovorin at 200 mg/m2, oxaliplatin at 85 mg/m2, and bolus fluorouracil at 400 mg/m2, all on day 1, followed by 2400 mg/m2/46 h, each 14-day cycle) were administered.
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