PMC5995723_01
Contrast-enhanced computed tomography (CT) of the abdomen at admission. (A) An axial view and (B) a coronal view in the arterial phase. (A, B) Multiple enhanced lesions (yellow arrows) were observed in the liver. The borders of the lesions were irregular and some had central low-density areas. (C) An axial view in the delayed phase. The lesions were uniformly enhanced. It was not possible to exclude the possibility of colon cancer metastasis based on these findings.
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All of the lesions showed early-phase contrast enhancement and some also showed a relatively low-density area in the central region (Fig. 1A and B). There also appeared to be high-density areas in the late-phase of contrast enhancement (Fig. 1C).
The pathological findings of the sigmoid colon cancer. (A) A macroscopic image shows a superficial elevated type tumor (black arrows; size 15x12 mm). (B) Victoria blue, Hematoxylin and Eosin staining of the tumor shows well-differentiated adenocarcinoma with submucosal invasion and massive venous invasion (black arrows).
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No cancer cells were found in the 25 dissected LNs (pT1N0M0, UICC 7th Stage I; Fig. 2).
The pathological findings of the liver lesion in segment 8. (A) The macroscopic image indicates that the hepatic lesion (black arrows) was a homogeneous lesion that was mahogany in color. (B) Hematoxylin and Eosin (H&E) staining of the hepatic lesion. The legion had several necrotic regions and an irregular border without a capsule. (C) Eosinophilic-rich granuloma with a palisade of epithelioid histiocytes. (D) H&E staining and (E) Elastica van Gieson staining of the portal region. (D, E) The black arrows indicate obliterative phlebitis.The letters "a", "b", and "p" indicate the "interlobular artery", "interlobular bile duct", and "interlobular portal vein", respectively. (F) In the background liver, diffuse hepatic steatosis and eosinophilic and lymphocytic infiltration were also observed along the portal veins.
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A well-circumscribed mass lesion of 10 mm in diameter and with surfaces that appeared white or yellow was detected in the liver (Fig. 3A). The histopathological examination of the nodules was characterized by dense inflammatory infiltration with prominent eosinophils and necrotic lesions surrounded by epithelioid histiocytes (Fig. 3B and C). Obliterative phlebitis was observed in and around the abscesses (Fig. 3D and E). The background showed diffuse hepatic steatosis and eosinophilic infiltration along the portal veins (Fig. 3F).
Changes in the eosinophil count over the clinical course. Day zero indicates the date of surgery. The eosinophil counts dramatically decreased after surgery and have since remained in the normal range.
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After the resection of the sigmoid colon cancer, the eosinophil count suddenly returned to a normal level (Fig. 4).
Changes in the hepatic lesions on contrast enhanced CT before and after the resection of the sigmoid colon cancer. The enhanced lesions (yellow arrows), which represented HEAs were observed before surgery, but were not observed (white arrows) on contrast-enhanced CT at the 6-month follow-up examination (B).
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Six months later, contrast-enhanced CT showed that the remaining HEAs had also disappeared (Fig. 5A and B).