肝転移を伴わない大腸癌術後門脈腫瘍栓の１例

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  • A CASE OF PORTAL VEIN TUMOR THROMBUS WITHOUT LIVER METASTASIS AFTER SURGERY FOR COLON CANCER

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A 80-year-old man underwent sigmoidectomy for sigmoid colon cancer on November 12, 2003, which was moderately differentiated adenocarcinoma, S, type2, 65×22mm in size, whole-circumferential growth, ss, P0, H0, M(-), lyl, vl, nl, D3, aw(-), ow(-), ew(-), curA, and stage III a. The patient had been treated with UFT-E 400mg daily for postoperative chemotherapy. The patient was admitted to the hospital because of abdominal distention 18 months after the operation. Results of laboratory studies showed serious anemia, hypoproteinemia, and the increased serum CEA. Abdominal CT scan showed portal vein thrombus, dilated portal vein with cavernous transformation, ascites, lymph node swelling, and intestinal edema. The portal vein thrombus extended from the portal vein to umbilical portion and to the right anterior and posterior segmental branches, and was markedly enhanced in the portal phase shown by dynamic CT. The thrombus was diagnosed as tumor thrombus. The patient received palliative care owing to difficulty in receiving even chemotherapy. Two months later, the thrombus grew into the splenic vein, but liver metastasis was not found by following abdominal CT scan. The patient died of exacerbation of general condition 23 months after the operation. There have been few cases of portal vein tumor thrombus without liver metastasis originating from colon cancer, and we report the case with a review of the literature.

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