A Case of Liver Fibrosis with Splenomegaly after Oxaliplatin-Based Adjuvant Chemotherapy for Colon Cancer
A 45-yr-old Korean man presented with lower abdominal pain in June, 2011. Workup revealed obstructing descending colon mass with pericolic infiltration. He had no significant past medical history. The patient also denied any previous use of alcohol and was not taking any prescription medication or herb. Result of his initial laboratory physical examination was unremarkable, and all initial laboratory values were within normal limits. Evaluation for evidence of viral infection with either hepatitis B or C was negative. The patient underwent left hemicolectomy of the primary T4N2M0 (Stage III) tumor. Surgical pathology revealed moderately differentiated adenocarcinoma of colon. He was then treated with 12 cycle of FOLFOX4 (5-flurouracil [Day 1, 2: 400 mg/m2 + 600 mg/m2]+ oxapliplatin [Day 1: 85 mg/m2] over a 6-month period. The latter part of this treatment was complicated by persistent thrombocytopenia (lowest platelet count of 52,700/µL during chemotherapy). Restaging CT scans demonstrated a good response to treatment. But 4 month after treatment, splenomegaly was noted radiographically (). Gastro-esophageal varix was not observed in endoscopy, but we postulated portal hypertension from splenomegaly with enlarged splenic artery and portal vein. Five month after chemotherapy, he underwent right hepatectomy due to isolated metastatic lesion in S6 and S8 lobe. Platelet count ranged 100,000/µL when hepatectomy was peformed. The liver parenchyma showed diffuse sinusoidal dilatation and centrilobular vein fibrosis with liver cell necrosis without steatosis. To investigate the pathogenesis of liver fibrosis, immunohistochemical stains such as CD31 and α-SMA were conducted with control group which was obtained from grossly normal autopsy liver. The immunohistochemical stains for CD31 and α-SMA were positive along the sinusoidal spaces in the patient, while negative in the control group (). After operation, the patient is currently being treated with systemic chemotherapy.