A Case of Gastric Cancer with Portal Vein Thrombosis Suspected to be Tumor Embolism and Liver Metastasis

Abstract

A 67-year-old man presented with anemia. Endoscopic examination showed a type 3 tumor located at the greater curvature of the stomach. Examination of the biopsy specimen showed gastric cancer, and he was referred to our hospital. An enhanced computed tomography (CT) scan showed a low-density area at liver S7, as well as a soft tissue neoplasm in the right branch of the portal vein. He was diagnosed as having advanced gastric cancer with liver metastasis and portal vein tumor embolus because abdominal ultrasonography and MRI (EOB) showed the same findings. Since the tumor embolus and liver metastasis enlarged after 3 courses of S-1 plus CDDP chemotherapy, it was changed to S-1 plus CPT-11. The liver metastasis vanished, and the tumor embolus shrank markedly with 2^nd-line chemotherapy. Since curative resection was judged possible, he underwent distal gastrectomy and right lobectomy. Pathological examination of the resected specimen showed that there was no metastasis in the liver, and the soft tissue neoplasm suspected to be tumor embolus was a thrombus. He has been alive with no tumor recurrence for the past 8 years and 4 months without adjuvant chemotherapy. This case was extremely difficult to diagnose because portal vein thrombus showed an irregular course similar to that of tumor thrombosis.