Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
J Korean Med Sci. 2013 Dec;28(12):1835-8. doi: 10.3346/jkms.2013.28.12.1835. Epub 2013 Nov 26.
Previous studies reported that oxaliplatin is associated with sinusoidal obstruction syndrome. However few reports on oxaliplatin induced liver fibrosis are found in the literature. Furthermore pathogenesis of liver fibrosis is not well known. We report a case of 45-yr-old Korean man in whom liver fibrosis with splenomegaly developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for colon cancer (T4N2M0). Thorough history taking and serological examination revealed no evidence of chronic liver disease. Restaging CT scans demonstrated a good response to chemotherapy. Five month after chemotherapy, he underwent right hepatectomy due to isolated metastatic lesion. The liver parenchyma showed diffuse sinusoidal dilatation and centrilobular vein fibrosis with necrosis without steatosis. We could conclude that splenomegaly was due to perisinusoidal liver fibrosis and liver cell necrosis induced portal hypertension by oxaliplatin. In addition, to investigate the pathogenesis of liver fibrosis, immunohistochemical stains such as CD31 and α-smooth muscle actin (α-SMA) were conducted with control group. The immunohistochemical stains for CD31 and α-SMA were positive along the sinusoidal space in the patient, while negative in the control group. Chemotherapy with oxaliplatin induces liver fibrosis which should be kept in mind as a serious complication.
先前的研究报道奥沙利铂与窦状隙阻塞综合征有关。然而，文献中很少有奥沙利铂引起肝纤维化的报道。此外，肝纤维化的发病机制尚不清楚。我们报告了一例 45 岁韩国男性，在结肠癌（T4N2M0）接受基于奥沙利铂的辅助化疗 12 周期后，出现肝纤维化伴脾肿大。详细的病史询问和血清学检查未发现慢性肝病的证据。重新分期 CT 扫描显示化疗有良好的反应。化疗 5 个月后，因孤立性转移病灶行右半肝切除术。肝实质表现为弥漫性窦状扩张和中央静脉纤维化伴坏死，无脂肪变性。我们可以得出结论，奥沙利铂引起的窦周肝纤维化和肝细胞坏死导致门静脉高压引起脾肿大。此外，为了探讨肝纤维化的发病机制，对患者进行了 CD31 和 α-平滑肌肌动蛋白（α-SMA）等免疫组织化学染色，并与对照组进行了比较。患者的免疫组织化学染色 CD31 和 α-SMA 沿窦状隙呈阳性，而对照组为阴性。奥沙利铂化疗可引起肝纤维化，应将其视为严重的并发症。
