Focal Sinusoidal Obstruction Syndrome Caused by Oxaliplatin-Induced Chemotherapy: A Case Report.

INTRODUCTION: Sinusoidal obstruction syndrome (SOS) is a severe adverse event of long-term chemotherapy in patients with colorectal cancer. It usually develops as liver congestion due to diffuse microscopic obstruction in liver parenchyma. In contrast, it sometimes appears as a liver mass occurring with local parenchymal hemorrhaging, and is often misdiagnosed as liver metastasis. CASE PRESENTATION: A 40-year-old woman with rectal cancer underwent high anterior resection and partial liver resection of segment 7 due to synchronous liver metastasis. She received oxaliplatin-based chemotherapy (mFOLFOX6) as adjuvant chemotherapy for 6 months. A 13-mm irregular low-echoic mass was detected by CT in segment 3 of the liver 12 months after the operation. The mass was again resected as a liver metastasis because it had increased in size. The pathological diagnosis was focal SOS, which showed sinusoidal dilation and congestion by hepatocyte trabeculae in the liver parenchyma. CONCLUSIONS: Atypical irregular tumors should be considered as SOS when the patient has received oxaliplatin-based chemotherapy. A qualitative imaging modality diagnosis, such as with diffusion-weighted MRI, is superior to a morphological diagnosis in focal SOS. This imaging modality can prevent unnecessary operations.

A Longitudinal Computed Tomography Imaging in the Diagnosis of Gallbladder Cancer.

Background/Aim. To assess whether the diagnostic power of longitudinal multiplanar reformat (MPR) images is superior to that of conventional horizontal images for gallbladder cancer (GBC). Methods. Between 2006 and 2010, a total of 54 consecutive patients with preoperatively diagnosed gallbladder neoplasms located in gallbladder bed were analyzed. These patients underwent cholecystectomy with resection of the adjacent liver parenchyma. The patients were divided into the GBC group (n = 30) and the benign group (n = 24). MPR images obtained by preoperative multidetector row CT (MDCT) were assessed. Results. Mucosal line was more significantly disrupted in GBC group than that in benign group (93% [28/30 patients] versus 13% [3/24], p < 0.001). Maximum (9.3 [4.2-24.8] versus 7.0 mm [2.4-22.6], p = 0.29) and minimum (1.2 [1.0-2.4] versus 1.3 mm [1.0-2.6], p = 0.23) wall thicknesses on a single MPR plane did not differ significantly; however, the wall thickness ratio (max/min) differed significantly (6.8 [1.92-14.0] versus 5.83 [2.3-8.69], p = 0.04). Partial liver enhancement adjacent to tumor on longitudinal images was more common in GBC (40.0% [12/30 patients] versus 12.5% [3/24], p = 0.03). Mucosal line disruption was the most reliable independent predictor of diagnosis (odds ratio, 8.5; 95% CI, 5.99-28.1, p < 0.001). Conclusion. Longitudinal MPR images are more useful than horizontal images for the diagnosis of GBC.

Good candidates for a third liver resection of colorectal metastasis.

BACKGROUND: Having three liver resections for colorectal metastases has long been considered to be associated with a high risk of postoperative complications. The present study was designed to assess the feasibility and survival benefits of three liver resections. METHODS: Between 2004 and 2011, data for 273 consecutive patients with colorectal metastases were analyzed. The patient characteristics, tumor status, operation-related variables, degree of liver steatosis, and short- and long-term outcomes were compared according to the number of liver resections. RESULTS: The history of preoperative chemotherapy was higher for patients who had had three liver resections as compared with other resections: i.e., one resection 41.0 %, versus two resections 56.8 %, versus three resections 81.8 %; p = 0.04. Patients receiving three liver resections had a high rate of liver steatosis (17.9 vs. 32.4 vs. 59.1 %; p = 0.03). The median operative time for three resections was significantly longer than for the other resections (359 min [range: 115-579 min] vs. 395 min [range: 178-740 min], vs. 482 min [range: 195-616 min]; p = 0.04). However, the complication rate and the postoperative hospital stay did not differ among the three groups. The 1-, 3- and 5-year survival rates did not differ significantly among the three groups (83.3, 57.5, and 44.6 % for one resection vs. 92.3, 52.1, and 35.7 % for two resections vs. 93.3, 49.0, and 34.1 % for three resections). Patients who had <5 tumors at a third liver resection and a recurrence interval of ≥ 500 days from the second resection were good candidates for three resections. CONCLUSIONS: Undergoing three resections of colorectal metastasis is feasible and provides a similar survival benefit as one or two resections, without increasing morbidity or mortality.

[A case of rectal cancer with sacrum metastasis treated with S-1 leading to a complete response].

The patient is a 47-year-old female. She had undergone abdominoperineal resection for rectal cancer at 39 years of age. Two years and 9 months after surgery, she was diagnosed with a vagina invasion. Radiation therapy and chemotherapy (UFT/ LV) were performed. After 4 courses of UFT/LV, a complete response (CR) was noted. Four years and 3 months after surgery, she was diagnosed with a sacrum metastasis. Chemotherapy with S-1 was performed. After 2 courses of S-1, a CR was noted. There has been no recurrence sign to date.

Malignant Peritoneal Mesothelioma Mimicking Ischemic Colitis.

The prognosis of malignant peritoneal mesothelioma is extremely poor with a mean survival time of 12 months. The initial symptoms are poor and atypical. Because of its rare entity and little knowledge of its treatments, there are few reports of long-term survival. We encountered a very unique case with strong impression on radiological findings of malignant peritoneal methothelioma. We had misdiagnosed it because of the findings and because the time course was similar to that of ischemic colitis. The radiological findings on CT and enema disappeared within one week after antibiotic therapy.

Arterial stimulation and venous sampling (ASVS) is useful for recurrent lesions of insulinoma: a case report.

We encountered a recurrent case of benign solitary insulinoma in the pancreatic tail, which may have been caused by an inadequate surgical margin in the use of an ultrasonic dissector. A 45-year-old man was referred with hypoglycemia and diagnosed solitary insulinoma in the pancreas. Laparoscopic pancreatic enucleation was performed using an ultrasonic dissector. The tumor was extracted and the surgical margins were microscopically negative. Six years later, he presented with hypoglycemia again. Multiple small well-enhanced lesions were detected by computed tomography distant from the resection stump of the first operation. He underwent resection of all visible lesions with omentum and wide excision of the soft tissue surrounding the pancreas after preoperative arterial stimulation and venous sampling test. The postoperative course of the second operation was uncomplicated and the patient presents no sign of hypoglycemia after 12 months.