Department of Premedical Course, Chosun University School of Medicine, Gwangju 501-717, South Korea.
Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea.
World J Gastroenterol. 2017 Sep 7;23(33):6187-6193. doi: 10.3748/wjg.v23.i33.6187.
Arterioportal shunt (APS) is an organic communication between the hepatic arterial system and the portal venous system. The APS is one of the major causes of transient hepatic attenuation differences on dynamic computed tomography (CT) or magnetic resonance imaging (MRI). This condition is usually associated with trauma, liver cirrhosis, and malignancies of the liver. However, there has been no report about oxaliplatin-induced APS. A 41-year-old male was diagnosed with Stage IIIB gastric cancer. The patient initially underwent neoadjuvant chemotherapy with capecitabine and oxaliplatin After 3 cycles of therapy, the mass had markedly decreased, and a total gastrectomy with splenectomy was performed. Since the malignancy was locally invasive, the patient was continued on the same regimen of the adjuvant chemotherapy. After 3 more cycles, a computed tomography revealed a 1 cm sized arterial-enhancing nodule in the right lobe of the liver. An MRI revealed an arterial enhancing lesion, and a positron emission tomography CT scan showed a hypermetabolic lesion in the same portion of the liver. We tried to perform a liver biopsy; however, an ultrasonography could not detect any mass. A presumptive diagnosis of an APS due to a recurred cancer was made. We found a similar but slightly different case report of an oxaliplatin-induced liver injury, mimicking a metastatic tumor on an MRI. Based on a prior report, the patient was continued on treatment with adjuvant chemotherapy following discontinuation of oxaliplatin. After 2 cycles, the arterial enhancing liver mass resolved, supporting the final diagnosis of an APS, related to oxaliplatin-induced sinusoidal injury. The patient has not experienced any a relapse after two years of additional follow up recurrent gastric cancer upon interpretation of multiple imaging modalities.
动静脉分流（APS）是肝动脉系统和门静脉系统之间的一种有机联系。APS 是动态计算机断层扫描（CT）或磁共振成像（MRI）上短暂性肝衰减差异的主要原因之一。这种情况通常与创伤、肝硬化和肝脏恶性肿瘤有关。然而，目前尚无奥沙利铂引起的 APS 报告。一名 41 岁男性被诊断为 IIIB 期胃癌。患者最初接受卡培他滨和奥沙利铂的新辅助化疗。在 3 个周期的治疗后，肿块明显缩小，并进行了全胃切除术和脾切除术。由于恶性肿瘤局部侵袭，患者继续接受相同方案的辅助化疗。再进行 3 个周期后，计算机断层扫描显示肝脏右叶有 1 厘米大小的动脉增强结节。MRI 显示动脉增强病变，正电子发射断层扫描 CT 扫描显示肝脏同一部位的高代谢病变。我们试图进行肝活检；然而，超声检查未能检测到任何肿块。因此诊断为癌症复发引起的 APS。我们发现了一个类似但略有不同的奥沙利铂引起的肝损伤病例报告，该损伤在 MRI 上模拟转移性肿瘤。根据先前的报告，在停止奥沙利铂治疗后，患者继续接受辅助化疗。在 2 个周期后，动脉增强的肝脏肿块消退，支持奥沙利铂诱导的窦状间隙损伤引起 APS 的最终诊断。在两年的额外随访后，患者未经历任何复发，也未出现其他与奥沙利铂相关的并发症。
