J Korean Med Sci.  2013 Dec;28(12):1835-1838. 10.3346/jkms.2013.28.12.1835.

A Case of Liver Fibrosis with Splenomegaly after Oxaliplatin-Based Adjuvant Chemotherapy for Colon Cancer

• Kang GH
• Moon HS
• Lee ES
• Kim SH
• Sung JK
• Lee BS
• Jeong HY
• Lee HY
• Kang DY

• KMID: 1779429
• DOI: http://doi.org/10.3346/jkms.2013.28.12.1835

Abstract

Previous studies reported that oxaliplatin is associated with sinusoidal obstruction syndrome. However few reports on oxaliplatin induced liver fibrosis are found in the literature. Furthermore pathogenesis of liver fibrosis is not well known. We report a case of 45-yr-old Korean man in whom liver fibrosis with splenomegaly developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for colon cancer (T4N2M0). Thorough history taking and serological examination revealed no evidence of chronic liver disease. Restaging CT scans demonstrated a good response to chemotherapy. Five month after chemotherapy, he underwent right hepatectomy due to isolated metastatic lesion. The liver parenchyma showed diffuse sinusoidal dilatation and centrilobular vein fibrosis with necrosis without steatosis. We could conclude that splenomegaly was due to perisinusoidal liver fibrosis and liver cell necrosis induced portal hypertension by oxaliplatin. In addition, to investigate the pathogenesis of liver fibrosis, immunohistochemical stains such as CD31 and alpha-smooth muscle actin (alpha-SMA) were conducted with control group. The immunohistochemical stains for CD31 and alpha-SMA were positive along the sinusoidal space in the patient, while negative in the control group. Chemotherapy with oxaliplatin induces liver fibrosis which should be kept in mind as a serious complication.

Keyword

Liver Cirrhosis; Splenomegaly; Oxaliplatin

MeSH Terms

Actins/metabolism
Antigens, CD31/metabolism
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Camptothecin/*analogs & derivatives/therapeutic use
Chemotherapy, Adjuvant
Colonic Neoplasms/*drug therapy
Fluorouracil/therapeutic use
Humans
Hypertension, Portal/etiology
Immunohistochemistry
Leucovorin/therapeutic use
Liver Cirrhosis/*diagnosis/etiology/pathology
Liver Neoplasms/secondary/surgery
Male
Middle Aged
Organoplatinum Compounds/*administration & dosage/adverse effects/therapeutic use
Splenomegaly/*diagnosis/etiology
Thrombocytopenia/etiology
Tomography, X-Ray Computed
Actins
Antigens, CD31
Camptothecin
Fluorouracil
Leucovorin
Organoplatinum Compounds

Figure

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  Fig. 1 Abdominal CT finding of spleen. (A) Before operation and chemotherapy the maximal spleen diameter was 105 mm, (B) After operation and chemotherapy (5 month after last chemotherapy) the maximal spleen diameter was 131 mm.

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  Fig. 2 Histologic finding of the liver parenchyma. (A) It revealed liver cell necrosis and perisinusoidal fibrosis (H&E, ×100). (B) Masson's trichrome stain. Diffuse fibrosis in portal area and perisinusoidal space (MT, ×100). (C) Negative stain of CD31 in the control group. (D) CD31 immunohistochemical stain. Diffuse positive in sinusoidal wall, central vein and portal vein branch wall (CD31, ×200). (E) Negative stain of α-SMA in the control group. (F) α-SMA immunohistochemical stain. Diffuse positive in sinusoidal wall, central vein and portal vein or hepatic artery branch wall (α-SMA, ×200).

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