Successful surgical treatment of gastric cancer with a tumor thrombus in the portal and splenic veins: report of a case

Gastric cancer simultaneously complicated with extrahepatic bile duct metastasis and portal vein tumor thrombus: a case report

BACKGROUND

Gastric cancer metastatic to the extrahepatic bile duct or accompanied by portal vein tumor thrombus (PVTT) is rare. To our knowledge, there have been no cases complicated with both of these factors.

CASE PRESENTATION

A 72-year-old man presented with icterus and melena. A biochemical blood test showed abnormal values for hepatobiliary enzymes and a tumor marker, and abdominal computed tomography scan revealed wall thickening of the lower bile duct with intra- and extra-hepatic bile duct dilatation and PVTT. A biopsy of the lower bile duct during endoscopic retrograde cholangiopancreatography demonstrated a moderately differentiated tubular adenocarcinoma. Moreover, gastroduodenoscopy showed a type 3 tumor at the lesser curvature of the gastric antrum, and an endoscopic biopsy demonstrated a moderately differentiated tubular adenocarcinoma. We diagnosed concomitant gastric cancer and distal bile duct accompanied by PVTT, and pancreatoduodenectomy with combined resection of the portal vein was performed. The resected specimen revealed a tumor in the lesser curvature of the gastric antrum and circumferential wall thickening in the lower bile duct. In pathological findings, infiltration of a moderately differentiated tubular adenocarcinoma from the mucosal layer to the subserosal layer of the stomach was observed. In contrast, a moderately differentiated tubular adenocarcinoma demonstrating the same histological type as the gastric cancer had spread not to the mucosal layer but mainly to the fibromuscular layer of the lower bile duct. Immunohistochemical staining showed identical patterns between gastric cancer and the bile duct tumor: negativity for cytokeratin 7 (CK7), and positivity for CK19 and 20. Therefore, the final diagnosis was extrahepatic bile duct metastasis from gastric cancer with PVTT. Unfortunately, multiple liver metastases occurred in the early postoperative period and chemotherapy was conducted, but the patient died 12 months after the surgery.

CONCLUSIONS

In the diagnosis of extrahepatic bile duct metastasis, immunohistochemical staining of gastric cancer and the bile duct tumor was essential and helpful as decisive evidence.

Successful Management of Advanced Gastric Cancer With Bulky Lymph Node Metastases and Tumor Thrombus in the Portal Vein System: A Case Report

Background:

Gastric cancer cases with tumor thrombus in the portal vein system (PVTT) are rare, frequently develop liver metastasis, and have a very poor prognosis.

Case presentation:

A 65-year-old man presented to a physician with a complaint of upper abdominal pain persisting for 2 months. Esophagogastroduodenoscopy revealed a Borrmann type 2 tumor, and he was referred to our hospital. Computed tomography (CT) showed wall thickening of the stomach, bulky swelling of lymph nodes in the lesser curvature and along the pancreas body, and tumor thrombus in the splenic to the portal vein. CT showed no liver or lung metastases, ascites, or peritoneal nodules. Staging laparoscopy revealed P0CY0. We planned to administer neoadjuvant chemotherapy (NAC), consisting of 2 courses of TS-1 and cisplatin combined chemotherapy. However, the second course of the chemotherapy was canceled on day 8 because of influenza. CT after chemotherapy showed no remarkable change, but we decided to undertake the planned operation. Total gastrectomy and pancreaticosplenectomy, along with lymphadenectomy, thrombectomy, and cholecystectomy, was performed. The patient was discharged on postoperative day 12 without complications. Histopathologic examination showed a well to moderately differentiated adenocarcinoma with 45 lymph node metastases. The specimen of the tumor thrombus also showed a moderately differentiated adenocarcinoma. Because he did not want additional chemotherapy, we selected follow-up observation. The patient has remained disease-free for 60 months after the operation.

Conclusion:

We described a patient with advanced gastric cancer with PVTT, who could undergo R0 resection with a good clinical course.

Isolated Superior Mesenteric Vein Tumor Thrombus in a Patient with Gastric Cancer

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.

Long-Term Survival of a Patient with Adenocarcinoma of the Esophagogastric Junction with a Portal Vein Tumor Thrombosis Who Underwent Palliative Total Gastrectomy: A Case Report

Portal vein tumor thrombosis (PVTT) with advanced gastric cancer is very rare; when it occurs, it exhibits aggressive growth and carries a poor prognosis. In addition, definitive treatment has not been established due to insufficient data. Herein, we report a case of PVTT associated with an adenocarcinoma of the esophagogastric junction that was successfully controlled by means of a palliative total gastrectomy without surgical resection of the PVTT and administration of palliative continuous doxifluridine.

Successful treatment of advanced gastric adenocarcinoma with portal tumor thrombosis by total gastrectomy following CDDP and S-1 therapy

Gastric cancers with portal tumor thrombosis (GCPTs) are a rare entity, often concomitant with hematogenous metastases, and chemotherapy is mainly used to treat them. However, the outcome of GCPT is reported to be dismal. We experienced a case of GCPT with splenic metastases. A 53-year-old man was admitted for anorexia. Upper gastrointestinal scope revealed type 3 gastric cancer of the stomach. Abdominal computed tomography showed a huge tumor thrombus in the splenic vein extending to the hepatic hilus and multiple metastases to the spleen. S-1 was given orally from day 1 to day 21 and 60 mg of CDDP was administered intravenously. The cancerous thrombosis in the portal system and splenic metastases disappeared due to chemotherapy. Total gastrectomy with lymphadenectomy and splenectomy was carried out with curative intent after 10 courses of chemotherapy. Intraoperatively, no tumor thrombosis was identified and the gastric tumor was surgically removed. After surgery, the patient received adjuvant chemotherapy of S-1. After 6 months he is well and has not suffered from tumor relapse. A combination of CDDP + S-1 plus intervention surgery seems to be a promising option for GCPT.

Survival analysis of gastric cancer patients with tumor thrombus in the portal vein

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.

A case of acinar cell carcinoma of the pancreas that formed extensive tumor thrombus of the portal vein

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.