Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2017; 23(33): 6187-6193
Published online Sep 7, 2017. doi: 10.3748/wjg.v23.i33.6187
Arterioportal shunt incidental to treatment with oxaliplatin that mimics recurrent gastric cancer
Hong-Beum Kim, Sang-Gon Park
Hong-Beum Kim, Department of Premedical Course, Chosun University School of Medicine, Gwangju 501-717, South Korea
Sang-Gon Park, Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
Supported by: The National Research Foundation of Korea (NRF), funded by the Ministry of Science, ICT, and Future Planning, No. NRF-2015R1A5A2009070; research fund from Chosun University, 2015.
Author contributions: Kim HB were the major contributors in writing the manuscript; Park SG were involved in drafting, writing and editing the manuscript, and reviewed the manuscript as corresponding author; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sang-Gon Park, MD, PhD, Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, South Korea. sgpark@chosun.ac.kr
Telephone: +82-62-2203984 Fax: +82-62-2349653
Received: March 15, 2017
Peer-review started: March 16, 2017
First decision: May 12, 2017
Revised: May 31, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: September 7, 2017
Processing time: 175 Days and 13.4 Hours
Abstract

Arterioportal shunt (APS) is an organic communication between the hepatic arterial system and the portal venous system. The APS is one of the major causes of transient hepatic attenuation differences on dynamic computed tomography (CT) or magnetic resonance imaging (MRI). This condition is usually associated with trauma, liver cirrhosis, and malignancies of the liver. However, there has been no report about oxaliplatin-induced APS. A 41-year-old male was diagnosed with Stage IIIB gastric cancer. The patient initially underwent neoadjuvant chemotherapy with capecitabine and oxaliplatin After 3 cycles of therapy, the mass had markedly decreased, and a total gastrectomy with splenectomy was performed. Since the malignancy was locally invasive, the patient was continued on the same regimen of the adjuvant chemotherapy. After 3 more cycles, a computed tomography revealed a 1 cm sized arterial-enhancing nodule in the right lobe of the liver. An MRI revealed an arterial enhancing lesion, and a positron emission tomography CT scan showed a hypermetabolic lesion in the same portion of the liver. We tried to perform a liver biopsy; however, an ultrasonography could not detect any mass. A presumptive diagnosis of an APS due to a recurred cancer was made. We found a similar but slightly different case report of an oxaliplatin-induced liver injury, mimicking a metastatic tumor on an MRI. Based on a prior report, the patient was continued on treatment with adjuvant chemotherapy following discontinuation of oxaliplatin. After 2 cycles, the arterial enhancing liver mass resolved, supporting the final diagnosis of an APS, related to oxaliplatin-induced sinusoidal injury. The patient has not experienced any a relapse after two years of additional follow up recurrent gastric cancer upon interpretation of multiple imaging modalities.

Keywords: Liver; Arterioportal shunt; Recurred cancer; Oxaliplatin; Transient hepatic attenuation differences

Core tip: Although there have been several recent reports about oxaliplatin-induced sinusoidal injury, this is first case report of a non-tumorous incidental arterioportal shunt following oxaliplatin chemotherapy. We made a presumptive diagnosis of an AP shunt mimicking a recurred gastric cancer, due to an oxaliplatin-induced transsinusoidal injury. This case is the first report of an oxaliplatin-induced incidental arterioportal shunt mimicking recurred gastric cancer on various images.