Ewha Med J.  2016 Oct;39(4):129-132. 10.12771/emj.2016.39.4.129.

Acute Liver Injury Caused by Diffuse Lymphangitic Liver Metastasis from Colon Cancer

• Chi HS
• Kim SY
• Kim MJ
• Hong EK
• Lee SH
• Shim CW

• KMID: 2356386
• DOI: http://doi.org/10.12771/emj.2016.39.4.129

Abstract

A 56-year-old man was diagnosed with cancer of the ascending colon along with retroperitoneal lymph node and peritoneal metastases. After six cycles of palliative chemotherapy, he presented with acute-onset jaundice. Imaging examinations did not show abnormal liver findings other than a periportal linear hypoattenuating area, and endoscopic retrograde cholangiography revealed a tight stricture of the proximal common bile duct. Total bilirubin continued to increase after endoscopic sphincterotomy and biliary stent insertion. Blind liver biopsy revealed tumor infiltration along liver lymphatics, but ruled out tumor involvement of hepatic parenchyma and sinusoids. Tumor cells were predominantly confined to within the lymphatic vessels and were not observed in the arteries or veins. Although one loading dose of cetuximab and two fractions of palliative radiotherapy were administered, the patient succumbed to acute liver injury 30 days after the development of jaundice.

Keyword

Lymphatic metastasis; Colon neoplasm; Liver

MeSH Terms

Arteries
Bilirubin
Biopsy
Cetuximab
Cholangiography
Colon*
Colon, Ascending
Colonic Neoplasms*
Common Bile Duct
Constriction, Pathologic
Drug Therapy
Humans
Jaundice
Liver*
Lymph Nodes
Lymphatic Metastasis
Lymphatic Vessels
Middle Aged
Neoplasm Metastasis*
Radiotherapy
Sphincterotomy, Endoscopic
Stents
Veins
Bilirubin
Cetuximab

Figure

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  Fig. 1 Abdominal computed tomography (CT). Liver CT (portal phase) shows a normal appearance except for the "periportal collar," observed as linear periportal hypoattenuating areas.

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  Fig. 2 Microscopic findings. H&E staining (×200) of the liver biopsy specimen shows interstitial infiltration of tumor cells (A). Immunohistochemical staining (×200) shows intense membranous expression of CK20 (B). Tumor cells are confined within lymphatic vessels, which express D2-40 (×400), a lymphatic epithelial marker (C).

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