Liver Metastasis Originating from Colorectal Cancer with Portal Vein Tumor Thrombosis: A Case Report and Review of the Literature

Abstract

Purpose. Macroscopic tumor thrombi occupying the main portal branch are rarely seen in patients with liver metastasis and have only been reported in 2.8% of cases. We present a case of liver metastasis from colon cancer with a prominent tumor thrombus in the portal vein.Case Report. A76-year-old woman underwent a laparoscopic right hemicolectomy for adenocarcinoma of the ascending colon. The postoperative condition was initially satisfactory. Five months after the surgery, the patient was admitted to our hospital due to general fatigue. Magnetic resonance imaging (MRI) showed extensive filling defects over the entire portal vein. No definite metastatic nodules were observed in the liver parenchyma during imaging. The tumor marker levels were increased, and colon cancer with tumor thrombosis within the portal vein was highly suspected. We recommended the patient undergo systemic chemotherapy or surgical intervention; however, she refused. The patient was readmitted to our hospital 3 months later with poor appetite and malaise. Abdominal computed tomography (CT) delineated multiple liver metastases and progression of the tumor thrombosis over the portal vein. Unfortunately, the patient passed away a few weeks later due to sepsis with hepatic failure.Conclusions. There is no consensus on the treatment for colorectal liver metastasis accompanying portal vein tumor thrombosis; a better prognosis may be expected if the tumor can be completely resected en bloc. Multimodality treatments including surgery and adjuvant therapies should be performed to improve the survival rate.