PMC9730029_01
Abdominal CT: Pre-chemotherapy (A, B, C), post-chemotherapy (D, E, F).. Computed tomography (CT) demonstrated a low attenuation solid mass on the PV/SMV (A, D) that is invading the GDA (B, E) and has an abutment with CA (C, F).
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Furthermore, the tumor had extended along the CHA beyond the root of the SpA and the abutment with the CA was recognized (Fig. 1).
3D-CT angiography.. The 3D-CT angiography reveals the existence of r-LHA. The root of the LGA (arrowhead) was not invaded by the tumor. The white lines show transected points of arteries.
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The root of the LGA was not invaded by the tumor (Fig. 2).
Views in the operation.. The GDA and PHA were involved in the tumor (A).. Extended DP-CAR was performed. The PV and SMV were reconstructed (B).
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D2 lymphadenectomy was also conducted (Fig. 3).
Postoperative course and the treatment timeline.. (A) Postoperative transition of serum liver enzymes: serum levels of AST and ALT were within normal limits on POD7.. (B) The right hepatic artery and whole liver parenchyma were well perfused on POD7.. (C) The treatment timeline.
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Serum liver enzymes were not elevated after the operation (Fig. 4A). Although temporary elevations of hepatic enzymes were observed, normalization of aspartate aminotransferase (AST) and alanine transaminase (ALT) was obtained on postoperative day seven (Fig. 4A). Contrast abdominal CT at seven days after surgery showed good blood supply to the entire liver (Fig. 4B). S-1100 mg/day from day 1 to day 28 was started a month after surgery. She had no evidence of the disease at her six-month follow-up visit (Fig. 4C).
Specimen examination.. Macroscopic findings showed the tumor surrounding the arteries. The maximum size of the tumor was 27 mm (A, B).. Histologic examination of resected tissue samples (C, D). Hematoxylin and eosin (H & E) staining original magnification x20 (C), x40 (D). (C, D) Although there was no evidence of invasion of the arteries, periarterial fibrosis was evident (carcinoma cells: yellow circle). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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Periarterial fibrosis was seen, indicating that chemotherapy killed the carcinoma cells around the arteries (Fig. 5).