Macroscopic portal vein tumor thrombi of liver metastasis from colorectal cancer

Department of Digestive Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
Journal of Hepato-Biliary-Pancreatic Surgery (Impact Factor: 1.6). 01/2009; 16(1):90-3. DOI: 10.1007/s00534-008-0005-2
Source: PubMed


We present a case of multiple colorectal liver metastases with macroscopic portal vein thrombi. A 55-year-old woman presented to us with rectosigmoid cancer and presented with two liver metastases. The tumor in the posterior sector was associated with invasion of first order branches of the portal vein. We performed low anterior resection, hepatic posterior sectorectomy and partial left anterior sectorectomy. Both the colorectal cancer and liver tumors exhibited histological characteristics of moderately differentiated adenocarcinoma with a substantial amount of mucin production. The liver metastases were associated with prominent tumor thrombi in many branches of the portal vein. Stronger staining for endoglin (CD 105) than for Fas ligand (Fas L) and matrix metalloproteinase (MMP-2) was observed in both the colorectal cancer and metastatic liver tumor cells. Expression of the vascular endothelial growth factor within the tumor cells was seen in both the colorectal cancer as well as the metastatic liver tumor cells. Six months after the operation, she was diagnosed to have multiple, more than about 20 liver metastases, and in 9 months after the operation, the patient died. The colorectal cancer with liver metastases associated with portal vein tumor thrombosis was poor prognosis, found neoplastic microvessel formation.

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    • "Many patients with liver metastasis of colorectal cancer accompanied by portal vein tumor thrombosis were reported to have developed metastasis or recurrence about 1 year after surgery and died, and some postoperative adjuvant chemotherapy is considered to have been conducted in many patients. In case reports in which postoperative adjuvant chemotherapy was not performed, refusal of the patients was mentioned as its reason [9]. Our patient showed recurrence and metastasis in the liver and lung after the end of postoperative adjuvant chemotherapy. "
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    ABSTRACT: The patient was a male in his 70s with a history of chronic renal failure and dilated cardiomyopathy. In January 2011, he underwent abdominoperineal resection of the rectum, right hepatic lobectomy, and resection of a portal vein tumor thrombus with a diagnosis of rectal cancer and metastatic liver cancer accompanied by portal vein tumor thrombosis. Although 5-fluorouracil + l-leucovorin therapy (RPMI regimen) was carried out as postoperative adjuvant chemotherapy, the tumor marker (CEA and VA19-9) levels increased 8 months after surgery. Since the functions of major organs were impaired, UFT(®) + UZEL(®) therapy was started. The tumor marker levels decreased temporarily, but increased again 12 months after surgery, and so intravenous instillation of panitumumab was initiated. Nine administrations have been performed to date, with no increase in tumor marker levels or exacerbation of the condition. Also, no grade 2 or severer adverse event has been noted according to CTCAE v.4.0. The experience with this patient suggests the possibility that exacerbation of the condition of patients with liver metastasis of colorectal cancer accompanied by portal vein tumor thrombosis with abnormalities in the functions of major organs can be controlled temporarily by the administration of panitumumab alone.
    Case Reports in Oncology 05/2013; 6(2):275-9. DOI:10.1159/000343680
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    • "Even the recent advance in chemotherapy and other treatment modalities, surgical resection is still gold standard for treatment of liver metastasis from colorectal cancer.12,13 Despite in patients with a macroscopic tumor thrombus in the main branch and/or trunk of the portal vein originating from colorectal cancer, a better prognosis may be expected if the tumor can be completely resected en bloc.14,15 Oppositely, the presence of PVTTs indicates a poor prognosis for patient with HCC, because of portal hypertension, rupture of esophageal varices, and liver failure.11 "
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    ABSTRACT: Metastatic lesions in the liver derived from colorectal cancer rarely invade the portal vein macroscopically. Portal vein tumor thrombus is commonly associated with hepatocellular carcinoma. Colorectal liver metastases are usually accompanied by microscopic tumor invasion into the intrahepatic portal vein, and the incidence of macroscopic tumor thrombus in the trunk of the portal vein is rare. Here, we provide unique appearance of metastatic colorectal cancer. To the best of our knowledge, macroscopically, the right portal vein filled with the tumor thrombus without any tumor in liver parenchyma has been quite rare.
    Rare tumors 10/2011; 3(4):e47. DOI:10.4081/rt.2011.e47
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    ABSTRACT: Macroscopic tumor thrombi occupying the main portal branch are rarely seen in patients with liver metastasis. A 55-year-old Japanese man who had previously undergone surgery for adenocarcinoma of the ascending colon presented with a metastatic liver tumor accompanied by a macroscopic tumor thrombus in the right portal branch. Right lobectomy and removal of the tumor thrombus were performed, and the liver metastasis and tumor thrombus were successfully resected. Histopathological examination of the liver tumor revealed adenocarcinoma, consistent with that of the previous colon cancer, confirming that the liver tumor was a metastasis from the colon cancer. Our patient remains well without recurrence at 51 months after the liver surgery. The prognosis of patients with liver metastasis accompanied by a portal vein tumor thrombus remains unknown, but, considering several previous reported cases together with our case report, a better prognosis may be expected if the tumor is successfully removed by anatomical liver resection.
    Journal of Medical Case Reports 11/2010; 4(1):382. DOI:10.1186/1752-1947-4-382


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