Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Road, Parel, Mumbai, 400012, India.
Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
J Gastrointest Cancer. 2023 Jun;54(2):682-686. doi: 10.1007/s12029-022-00835-x. Epub 2022 Jun 6.
Oxaliplatin-based chemotherapy is commonly used in adjuvant treatment of colon cancer as well as in neoadjuvant setting in patients with liver metastases. However oxaliplatin can cause damage to non-tumor bearing liver which presents as sinusoidal obstructive syndrome (SOS). These changes are difficult to differentiate from metastasis clinic-radiologically and manifests as sinusoidal dilatation, peliosis and nodular regenerative hyperplasia.
The present study reports the case of a patient with oxaliplatin-induced SOS which mimicked colo-rectal liver metastasis on follow up imaging studies after receiving neoadjuvant oxaliplatin based chemotherapy. After multidisciplinary discussion, patient was planned for simultaneous resection of rectal primary and right hepatectomy for metastasis. Final histopathology revealed no tumour in liver but the liver lesions seen radiologically were actually changes of oxaliplatin induced focal SOS and mimicked metastatic nodules.
In patients with colo-rectal cancer having received oxaliplatin-based chemotherapy, SOS may be considered as one of the causes of newly developed liver lesions, and should be subjected to additional radio-pathologic evaluation to prevent overtreatment and avoiding potentially morbid surgeries.
奥沙利铂为基础的化疗常用于结直肠癌的辅助治疗以及肝转移患者的新辅助治疗。然而，奥沙利铂可能会对无肿瘤的肝脏造成损伤，表现为肝窦阻塞综合征（SOS）。这些变化在临床上和影像学上很难与转移灶区分，表现为肝窦扩张、血窦增生和结节性再生性增生。
本研究报告了一例奥沙利铂诱导的 SOS 患者的病例，该患者在接受奥沙利铂为基础的新辅助化疗后随访影像学检查中模拟结直肠肝转移。经过多学科讨论，患者计划同时进行直肠原发灶和右半肝切除术以治疗转移灶。最终组织病理学检查显示肝脏无肿瘤，但影像学上所见的肝脏病变实际上是奥沙利铂诱导的局灶性 SOS 改变，模拟转移性结节。
在接受奥沙利铂为基础化疗的结直肠癌患者中，SOS 可能是新出现的肝脏病变的原因之一，应进行额外的放射病理评估，以防止过度治疗和避免潜在的有创手术。
