Macroscopic portal vein tumor thrombi of liver metastasis from colorectal cancer

Is hepatectomy an appropriate option for bilobar liver metastasis with portal vein tumor thrombus of colorectal cancer?

The prognosis of patients with multiple liver metastasis of colorectal cancer (CLM) on both lobes accompanied by a portal vein tumor thrombus (PVTT) remains unclear. We report two patients with multiple CLM and PVTT who underwent liver resection. A 73-year-old man had successful extended right hemi-hepatectomy with a thrombectomy for a macroscopic tumor thrombus in the right portal branch and multiple CLM in both lobes. At 8 months after surgery, the patient had multiple CLM in the remnant lobe with left main PVTT and died 14 months after liver surgery. A 64-year-old woman who had previously undergone palliative chemotherapy for adenocarcinoma of the ascending colon presented with CLM accompanied by a macroscopic tumor thrombus in the left portal branch. Tumor and PVTT had progressed despite various regimens of chemotherapy. Left hemi-hepatectomy with radiofrequency ablation on right lobe and right hemicolectomy were performed. However, CLM occurred again within 3 months after the liver surgery. Considering these cases, a poor prognosis may be expected even though the tumor is successfully removed by liver resection.

Role of imaging in visceral vascular emergencies

Differential diagnosis in non-traumatic acute abdomen is broad and unrelated diseases may simulate each other from a clinical perspective. Despite the fact that they are not as common, acute abdominal pain due to diseases related to visceral vessels may be life-threating if not detected and treated promptly. Thrombosis, dissection, and aneurysm in the abdominal visceral arteries or thrombosis in visceral veins may cause acute abdominal pain. Imaging with appropriate protocoling plays a fundamental role in both early diagnosis and determination of the treatment approach in these cases where early treatment can be life-saving. Computed tomography (CT) appears to be the most effective modality for the diagnosis as it provides high detail images in a very short time. Patient cooperation is also a less concern as compared to magnetic resonance imaging (MRI). As the imaging findings may sometimes be really subtle, diagnosis may be difficult especially to inexperienced imagers. Correct protocoling is also very critical to detect arterial abnormalities as visceral arterial abnormalities may not be detectable in portal phase only abdominal CT scans. In this article, we aimed to increase awareness among imaging specialists to these not very common causes of acute abdomen.

Chemotherapy for liver metastasis originating from colorectal cancer with portal vein tumor thrombosis: a case report

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.

Massive portal vein tumor thrombus from colorectal cancer without any metastatic nodules in the liver parenchyma

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.

Liver metastasis originating from colorectal cancer with macroscopic portal vein tumor thrombosis: a case report and review of the literature

Introduction

Macroscopic tumor thrombi occupying the main portal branch are rarely seen in patients with liver metastasis.

Case presentation

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.

Conclusion

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.