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Chen GY, Ren P, Gao Z, Yang HM, Jiao Y. Analysis of vascular thrombus and clinicopathological factors in prognosis of gastric cancer: A retrospective cohort study. World J Gastrointest Oncol 2024; 16:3436-3444. [PMID: 39171182 PMCID: PMC11334030 DOI: 10.4251/wjgo.v16.i8.3436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Gastric cancer (GC) is one of the most common malignant tumors in the world, and its prognosis is closely related to many factors. In recent years, the incidence of vascular thrombosis in patients with GC has gradually attracted increasing attention, and studies have shown that it may have a significant impact on the survival rate and prognosis of patients. However, the specific mechanism underlying the association between vascular thrombosis and the prognosis of patients with GC remains unclear. AIM To analyze the relationships between vascular cancer support and other clinicopathological factors and their influence on the prognosis of patients with GC. METHODS This study retrospectively analyzed the clinicopathological data of 621 patients with GC and divided them into a positive group and a negative group according to the presence or absence of a vascular thrombus. The difference in the 5-year cumulative survival rate between the two groups was compared, and the relationships between vascular cancer thrombus and other clinicopathological factors and their influence on the prognosis of patients with GC were analyzed. RESULTS Among 621 patients with GC, the incidence of vascular thrombi was 31.7% (197 patients). Binary logistic regression analysis revealed that the degree of tumor differentiation, depth of invasion, and extent of lymph node metastasis were independent influencing factors for the occurrence of vascular thrombi in GC patients (P < 0.01). The trend of the χ 2 test showed that the degree of differentiation, depth of invasion, and extent of lymph node metastasis were linearly correlated with the percentage of vascular thrombi in GC patients (P < 0.01), and the correlation between lymph node metastasis and vascular thrombi was more significant (r = 0.387). Univariate analysis revealed that the 5-year cumulative survival rate of the positive group was significantly lower than that of the negative group (46.7% vs 73.3%, P < 0.01). Multivariate analysis revealed that age, tumor diameter, TNM stage, and vascular thrombus were independent risk factors for the prognosis of GC patients (all P < 0.05). Further stratified analysis revealed that the 5-year cumulative survival rate of stage III GC patients in the thrombolase-positive group was significantly lower than that in the thrombolase-negative group (36.1% vs 51.4%; P < 0.05). CONCLUSION Vascular cancer status is an independent risk factor affecting the prognosis of patients with GC. The combination of vascular cancer suppositories and TNM staging can better judge the prognosis of patients with GC and guide more reasonable treatment.
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Affiliation(s)
- Guo-Yue Chen
- Department of Radiology, Jinan Central Hospital, Jinan 250013, Shandong Province, China
| | - Ping Ren
- Department of Radiology, Jinan Central Hospital, Jinan 250013, Shandong Province, China
| | - Zhen Gao
- Department of Radiology, Jinan Central Hospital, Jinan 250013, Shandong Province, China
| | - Hao-Ming Yang
- Department of Gastrointestinal Surgery, Jiangsu Provincial People's Hospital, Nanjing 210029, Jiangsu Province, China
| | - Yan Jiao
- Department of Radiology, Jinan Central Hospital, Jinan 250013, Shandong Province, China
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Yoshinaka H, Tanabe K, Hotta R, Saeki Y, Ohdan H. Revascularization for cavernous transformation radical lymphadenectomy in the treatment of gastric cancer: A case report. Int J Surg Case Rep 2018; 50:84-87. [PMID: 30086479 PMCID: PMC6085233 DOI: 10.1016/j.ijscr.2018.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION There are few reported cases of cavernous transformation of the portal vein (CTPV). CTPV is usually found by accident because most patients are asymptomatic at presentation. This paper reports a case of early gastric cancer with CTPV that required gastrectomy and revascularization. PRESENTATION OF CASE A 71-year-old man diagnosed with early gastric cancer, which was classified as clinical Stage IA (T1b, N0, M0) according to the TNM classification criteria for gastric cancer, was admitted to our hospital. Preoperative computed tomography (CT) revealed portal vein stenosis, CTPV, and esophageal varix. CT angiography showed that portal flow was maintained by the left gastric vein-right gastric vein (LGV-RGV) shunt. We had to perform lymphadenectomy while maintaining the hepatic blood flow. We performed distal gastrectomy with lymph node dissection including the vessel of the lesser curvature without massive bleeding. Postoperative course was uneventful, and CT examination performed in the 7th postoperative day revealed good blood flow from the reconstructed collateral vessels. The patient had no recurrence of gastric cancer during the postoperative period of 1 year. CONCLUSION Diseases that cause intra-abdominal inflammation, such as pancreatitis and choledocholithiasis, might cause CTPV. Thus, patients with this medical history should be carefully assessed for CTPV to avoid intraoperative complications, such as massive bleeding or ischemia. When we preform operation a case with CTPV, we must pay meticulous attention. In our case, we encountered some difficulties in the surgical procedure, especially with respect to the dissection of the regional lymph nodes for gastric cancer.
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Affiliation(s)
- Hisaaki Yoshinaka
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Kazuaki Tanabe
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan.
| | - Ryuichi Hotta
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yoshihiro Saeki
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
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Isolated Superior Mesenteric Vein Tumor Thrombus in a Patient with Gastric Cancer. Case Rep Surg 2018; 2018:3648436. [PMID: 29780653 PMCID: PMC5892258 DOI: 10.1155/2018/3648436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/07/2018] [Indexed: 11/18/2022] Open
Abstract
Tumor thrombus in the portal vein can rarely originate from gastric cancer via hematogenous spread, with only few case reports published in the literature. Isolated superior mesenteric vein tumor thrombus in gastric cancer has not been previously reported. A 61-year-old male patient who had undergone distal gastrectomy and gastroenterostomy for gastric ulcer 20 years ago was diagnosed with an obstructive tumor originating from the gastroenterostomy anastomosis site on upper gastrointestinal endoscopy that was performed for complaints of fatigue, oral feeding problems, and anemia. The PET-CT imaging revealed a hypermetabolic mass in the gastroenterostomy region along with hypermetabolic suspected tumor thrombus in the superior mesenteric vein (SMV). A suspected tumor thrombus with contrast enhancement that completely obstructed the SMV was detected on triphasic abdominal computed tomography. Decision for surgery was made due to gastric tumor obstruction. Firstly, lesions suspected with tumor thrombus were extirpated from the SMV and sent to frozen section. Then, it was completely recanalized. A locally advanced tumor originating from the gastroenterostomy anastomosis site that totally obliterated the lumen was observed on surgical exploration. After proving tumor thrombus by frozen, near-total gastrectomy was performed for palliative purposes. Histopathologic examination of the specimen showed gastric invasive adenocarcinoma and tumor thrombi in the SMV (T4N2M1). The patient received adjuvant chemotherapy, and he is at his 22nd-month follow-up with extensive hepatic metastases and intra-abdominal disease. It should be kept in mind that gastric cancer may lead to portal vein tumor thrombus or that it may rarely be associated with an isolated SMV tumor thrombus, both of which are associated with poor prognosis.
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Lee H, Chung WC, Lee KM, Paik CN, Kim JH, Jeon HS, Jun KH, Chin HM. [A case of gastric adenocarcinoma presenting as portal hypertension]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 60:42-6. [PMID: 22832799 DOI: 10.4166/kjg.2012.60.1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Portal vein thrombus has been detected in patients with liver cirrhosis, pancreatitis, ulcerative colitis, septicemia, myeloproliferative disorder, and neoplasm. The formation of portal tumor thrombus by hepatocellular carcinoma is well recognized, because of its high incidence, and subsequent development of portal hypertension such as rupture of varices, ascites and liver failure indicates the poor prognosis. In gastric cancer, portal hypertension as an initial presentation is extremely rare. Herein we report a case presenting as portal hypertension caused by tumor thrombus without invasion of liver parenchyma. It is presumed to be intraluminal tumor thrombus originating from primary foci of gastric adenocarcinoma. Tumor thrombus in the portal vein is demonstrated on the PET-CT.
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Affiliation(s)
- Hyewon Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Eom BW, Lee JH, Lee JS, Kim MJ, Ryu KW, Choi IJ, Cho SJ, Lee JY, Rhee J, Nam BH, Kim YW. Survival analysis of gastric cancer patients with tumor thrombus in the portal vein. J Surg Oncol 2011; 105:310-5. [PMID: 21898415 DOI: 10.1002/jso.22083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 08/05/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND A tumor thrombus in the portal vein originating from gastric cancer is a rare condition. Little is known about the development of portal vein tumor thrombus (PVTT) and its effect on the survival of gastric cancer patients. METHODS PVTT originating from gastric cancer was identified retrospectively with computed tomography in 51 patients, from January 2002 to June 2007. PVTT was classified by metastatic routes as follows: lymph node (LN), hepatic mass, and hematogenous type. The median survival from PVTT, and the factors affecting the survival of gastric cancer patients with PVTT were analyzed. RESULTS The median survival of gastric cancer patients with PVTT (N = 51) was 5.4 months. The median survival was compared according to clinical characteristics, and multivariate analysis proved that female and hepatic mass type were independent risk factors for poor prognosis. The characteristics of the hepatic mass type were old age, higher proportion of tumors located in the upper-third of the stomach, and liver metastasis, compared to the LN or the hematogeneous type. CONCLUSIONS PVTT originating from gastric cancer was a poor prognostic factor and the median survival from PVTT was different according to several clinical factors.
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Affiliation(s)
- Bang Wool Eom
- Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Gyeonggi-do, Korea
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Igarashi H, Shinozaki S, Mukada T. A case of acinar cell carcinoma of the pancreas that formed extensive tumor thrombus of the portal vein. Clin J Gastroenterol 2008; 2:96-102. [PMID: 26192173 DOI: 10.1007/s12328-008-0044-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 10/01/2008] [Indexed: 11/24/2022]
Abstract
A 58-year-old man was admitted to our hospital because of anorexia and back pain. He had been previously diagnosed with chronic pancreatitis with blood thrombus of the splenic vein at another hospital. Abdominal ultrasonography and computed tomography revealed a large mass in the body and tail of the pancreas, which directly invaded the stomach and the spleen. Small nodular metastases in both lungs were also detected. Furthermore, tumor thrombus continuously involved the splenic and proximal superior mesenteric vein, main portal vein, and its right intrahepatic branch. A metastatic mass was disclosed in the adjacent liver. The specimens obtained from portal tumor thrombus were histologically compatible with acinar cell carcinoma. Portal tumor thrombus is a rare condition in pancreatic tumors; however, it seems to be important to differentiate tumor thrombus from blood thrombus of the portal vein in order to know the true clinical stage and provide a suitable treatment.
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Affiliation(s)
- Hiroaki Igarashi
- Department of Gastroenterology, Kawakita Hospital, 1-7-3 Asagayakita, Suginami, Tokyo, 166-8488, Japan.
| | - Sachiko Shinozaki
- Department of Internal Medicine, Okubo Hospital, Shinjuku, Tokyo, Japan
| | - Takeo Mukada
- Department of Internal Medicine, Gunma Chuo Sogo Hospital, Maebashi, Gunma, Japan
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Lee MW, Lee JY, Kim YJ, Park EA, Choi JY, Kim SH, Lee JM, Han JK, Choi BI. Gastric hepatoid adenocarcinoma: CT findings. ACTA ACUST UNITED AC 2007; 32:293-8. [PMID: 16967243 DOI: 10.1007/s00261-006-9073-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In this study, we evaluated the CT findings of patients with hepatoid adenocarcinoma of the stomach. METHODS The CT scans of eight patients (seven males and one female; age range 44-70 years; mean age 59 years) with histologically proven hepatoid adenocarcinoma of the stomach were retrospectively evaluated by two radiologists in consensus. Scans were evaluated for gastric wall thickening, involved site enhancement, adjacent organ invasion, lymphadenopathy, distant metastases, and venous tumor thrombosis. RESULTS Tumors appeared as eccentric wall thickening (n = 8) and heterogeneous enhancement (n = 7). Adjacent organ invasions were noted to liver (n = 3), pancreas (n = 2), and esophagus (n = 1). All eight patients had a regional lymphadenopathy larger than 8 mm in its short axis. Distant metastases (liver, n = 4; non-regional lymph node, n = 1) were also noted. Venous tumor thrombosis was identified in the portal vein (n = 3), splenic vein (n = 1), main portal vein (n = 1), or right gastroepiploic vein (n = 1) in the regions near primary gastric tumors or metastatic masses. CONCLUSION On CT scans, hepatoid adenocarcinoma of the stomach appears as an eccentric gastric wall thickening and shows a strong tendency for liver and lymph node metastasis and venous invasion around the primary gastric tumor or a metastatic hepatic mass.
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Affiliation(s)
- Min Woo Lee
- Department of Radiology, Konkuk University Hospital, Seoul, South Korea
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Abstract
Advanced gastric cancer usually presents with symptoms due to direct extension into adjacent viscera, distant metastases from lymphatic or hematogenic dissemination and peritoneal seeding. However, portal hypertension as a presentation of metastatic gastric cancer is rare and usually seen in association with other malignancies, e.g. hepatocellular and pancreatic carcinoma. We report a case of signet ring adenocarcinoma of the stomach that presented with esophageal and duodenal varices and bleeding due to portal hypertensive gastropathy. Pagetoid spread of cancer cells likely caused early metastasis and the unusual presentation. We also discussed the pathophysiology of development of portal hypertension in association with malignancies.
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Affiliation(s)
- Pradipta Ghosh
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Diego, CA 92161, USA.
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Hackmon-Ram R, Holcberg G, Bashiri A, Sapir O, Tov GY, Yermiahu T, Mazor M. Thalassemia intermedia and cavernous transformation of portal vein thrombosis in pregnancy. Eur J Obstet Gynecol Reprod Biol 2003; 107:101-4. [PMID: 12593907 DOI: 10.1016/s0301-2115(02)00260-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a rare case of a cavernous transformation of portal vein (CTPV) thrombosis accompanied by Thalassemia and thrombophilia during pregnancy that was successfully treated by low molecular weight heparin. The clinical presentation, diagnosis and the treatment are discussed.
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Affiliation(s)
- Rinat Hackmon-Ram
- Division of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev PO Box 151 Beer Sheva 84101, Israel
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Bayraktar Y, Oztürk MA, Egesel T, Cekirge S, Balkanci F. Disappearance of "pseudocholangiocarcinoma sign" in a patient with portal hypertension due to complete thrombosis of left portal vein and main portal vein web after web dilatation and transjugular intrahepatic portosystemic shunt. J Clin Gastroenterol 2000; 31:328-32. [PMID: 11129276 DOI: 10.1097/00004836-200012000-00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The main portal vein web is probably a consequence of portal vein thrombosis, which is a very rare cause of portal hypertension. Principal manifestations are related to the degree of portal hypertension. In the literature, no data has been found for the treatment modality of portal vein web. We report, herein, the clinical and laboratory findings of a 38-year-old woman with angiographically proven incomplete main portal vein web and complete thrombotic occlusion of the left portal vein causing pseudocholangiocarcinoma sign (PCCS) on the common bile duct. She was treated by transjugular intrahepatic portosystemic shunt (TIPS) and membrane dilatation, which resulted in complete disappearance of collaterals and PCCS. It appears that TIPS and balloon dilatation of the portal vein web via transjugular approach was effective in decreasing portal pressure and its consequences.
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Affiliation(s)
- Y Bayraktar
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
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Abstract
Hepatic portal hypertension is an unusual complication of cancer therapy. The authors report 2 children under the age of 18 months with disseminated neuroblastoma who developed cavernous transformation of the portal vein during chemotherapy. While the older child remains well, the second patient succumbed from overwhelming variceal hemorrhage as a result of this condition. Full recovery of hepatic function is not invariable following the regression of extensive liver infiltration by neuroblastoma and consideration should be given to follow-up Doppler ultrasound imaging of the hepatic portal system in affected infants.
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Affiliation(s)
- S M Yule
- Department of Haematology, Yorkhill NHS Trust, Glasgow, UK
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Furui J, Enjyoji A, Okudaira S, Takayama K, Kanematsu T. Successful surgical treatment of gastric cancer with a tumor thrombus in the portal and splenic veins: report of a case. Surg Today 1998; 28:1046-50. [PMID: 9786577 DOI: 10.1007/bf02483959] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report herein the case of a 70-year-old woman with histologically confirmed gastric Borrmann type 3 cancer in the posterior wall of the fundus in whom computed tomography demonstrated a dilated portal trunk and splenic vein containing a low-density mass, but no evidence of liver metastases. The venous phase of a superior mesenteric arteriogram subsequently showed occlusion of the main portal vein with venous collaterals. At surgery, a tumor thrombus was noted to extend from the short gastric vein to the portal vein via the splenic vein. Thus, an extensive gastric resection together with removal of the tumor thrombus from the veins was performed, and successful results were achieved.
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Affiliation(s)
- J Furui
- Department of Surgery II, Nagasaki University School of Medicine, Nagasaki City, Japan
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Kauffman WM, Ribeiro RC. Cavernous transformation of the portal vein in a child with non-Hodgkin's lymphoma. MEDICAL AND PEDIATRIC ONCOLOGY 1997; 29:143-5. [PMID: 9180918 DOI: 10.1002/(sici)1096-911x(199708)29:2<143::aid-mpo14>3.0.co;2-g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We present an 11 year old boy who developed collateral vessels in the portal hepatis with non-visualization of the portal vein 9 months after treatment for large cell lymphoma. This "cavernous transformation of the portal vein" may lead to varices with subsequent gastrointestinal hemorrhage.
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Affiliation(s)
- W M Kauffman
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38163, USA
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