Ultrasonographic findings of portal tumor thrombus secondary to gastric cancer: Report of three cases

Abstract

Case 1, Borrmann's type 2 carcinoma detected by endoscopy in the body of the stomach of a 59-year-old man. Total gastrectomy with splenectomy was performed. Histologic examination revealed a poorly differentiated adenocarcinoma with marked venous invasion. Follow-up ultrasonography showed the tumor thrombi in the splenic vein to be progressively distended to the superior mesenteric vein and the peripheral branches of the intrahepatic portal vein.Case 2, Borrmann's type 4 carcinoma clinically diagnosed in a 77-year-old man. Ultrasonography detected tumor thrombi in the left gastric, splenic, and extrahepatic portal veins associated with cavernous transformation at the porta hepatis.Case 3, Moderately differentiated adenocarcinoma extending from the cardia to the middle body of the stomach diagnosed in a 69-year-old man. Ultrasonography detected a solid mass at the splenomesenteric confluence. Values of ot -fetoprotein (AFP) and protein induced by vitamin K antagonist-]I (PIVKA-]I) were markedly elevated.Recent progress in imaging technology will increase the probability of encountering the condition reported here. Color Doppler ultrasonography is useful for diagnosing portal thrombus and provides a great deal of information noninvasively.

A case of acinar cell carcinoma of the pancreas that formed extensive tumor thrombus of the portal vein

“…It is well recognized that the majority of liver metastases are hematogenous but this case demonstrated intraluminal metastasis forming extensive portal tumor thrombus. There has been only one case report of gastric cancer demonstrating the same mode of metastasis [22].…”

“…Only one case of acinar cell carcinoma has been reported so far [15] (Table 1). Although tumor thrombosis in the portal venous system is rarely recognized in patients with malignant tumors except for HCC, in addition to these pancreatic tumors, a few exceptional malignancies such as gastric cancer [16][17][18][19][20][21][22][23][24], colorectal cancer [4,23,[25][26][27][28][29][30][31], gallbladder cancer [32], renal cancer [33], malignant lymphoma [34][35][36], and malignant melanoma [37] have been reported to develop portal tumor thrombus.…”

“…On physical examination he felt tenderness in the left upper quadrant. Laboratory data on admission were as follows: serum lactate dehydrogenase 523 IU/L (normal 120-230), alkaline phosphatase 330 IU/L (150-320), total cholesterol 129 mg/dL (140-219), blood urea nitrogen 28.5 mg/dL (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), blood glucose 91 mg/dL (70-110), amylase 84 IU/L (50-160), lipase 585 IU/L (11-53), elastase-1 [5,000 ng/dL (100-400), phospholipase A2 5,250 ng/dL (130-400), trypsin [900 ng/dL (110-460). Carcinoembryonic antigen, carbohydrate antigen 19-9, DUPAN-2, and alpha-fetoprotein were all normal.…”

Gastric carcinoma with portal tumor thrombus

“…Color Doppler US in the same scanning plane of fi g. 3(2). Injection of contrast medium has enhanced the color Doppler results is carefully observed by color Doppler US, there is very little room for ambiguity in diagnosing PTT.…”