Ohara Hiroki, Ishibashi Yuji, Yoshimura Shuntaro, Yamazaki Ryoto, Hatao Fumihiko, Koshiishi Takeshi, Morita Yasuhiro, Imamura Kazuhiro
Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan.
Department of Surgery, Tokyo Metropolitan Matsuzawa Hospital, 2-1-1 Kamikitazawa, Setagaya-ku, Tokyo, 156-0057, Japan.
Surg Case Rep. 2020 Feb 18;6(1):39. doi: 10.1186/s40792-020-00806-z.
Intrahepatic artery pseudoaneurysms are mostly iatrogenic and result from hepatobiliary interventions. The incidence of intrahepatic artery pseudoaneurysms within liver tumors without prior intervention is extremely rare. We presented herein the first report of a case of an intratumoral pseudoaneurysm within a liver metastasis of gastric cancer without any prior intervention during chemotherapy.
A 59-year-old male patient underwent a distal gastrectomy and D2 lymph node dissection for gastric cancer. He was treated in the emergency room for right abdominal pain following the 4th cycle of nivolumab administration as second-line chemotherapy after adjuvant chemotherapy with S-1 and first-line chemotherapy for a liver metastasis of gastric cancer with ramucirumab plus paclitaxel. CT showed a 72-mm metastatic liver tumor containing a 9-mm pseudoaneurysm and fluid collection around the hepatic edge. Intrahepatic artery pseudoaneurysm within the metastatic liver tumor was diagnosed, with the surrounding fluid indicating potential, active bleeding. An emergency angiography confirmed the presence of a pseudoaneurysm in the intrahepatic artery, which was embolized using microcoils. The contributory causes of the intratumoral pseudoaneurysm were assumed to be the following: (1) tumor necrosis leading to encasement, erosion of the vessel wall, and subsequent arterial wall weakening; and (2) inhibition of vascular endothelial growth by ramucirumab resulting in a vessel wall breach and pseudoaneurysm formation.
It is necessary to recognize that pseudoaneurysms can arise within a metastatic liver tumor during chemotherapy.
肝内动脉假性动脉瘤大多是医源性的，由肝胆介入治疗引起。未经事先干预的肝肿瘤内肝内动脉假性动脉瘤的发生率极为罕见。我们在此报告首例在化疗期间未经任何事先干预的胃癌肝转移瘤内肿瘤内假性动脉瘤病例。
一名59岁男性患者因胃癌接受了远端胃切除术和D2淋巴结清扫术。在接受S-1辅助化疗和雷莫西尤单抗联合紫杉醇一线化疗后，作为二线化疗使用纳武单抗进行第4周期治疗后，他因右腹痛在急诊室接受治疗。CT显示一个72毫米的肝转移瘤，其中包含一个9毫米的假性动脉瘤以及肝边缘周围的液体积聚。诊断为转移性肝肿瘤内肝内动脉假性动脉瘤，周围的液体表明可能存在活动性出血。急诊血管造影证实肝内动脉存在假性动脉瘤，使用微线圈进行了栓塞。肿瘤内假性动脉瘤的促成原因被认为如下：（1）肿瘤坏死导致血管包绕、血管壁侵蚀以及随后的动脉壁变薄；（2）雷莫西尤单抗抑制血管内皮生长导致血管壁破裂和假性动脉瘤形成。
有必要认识到化疗期间转移性肝肿瘤内可能出现假性动脉瘤。
