HEMATOLOGY MEETS ONCOLOGY: AN INTERESTING CASE OF SPLENOMEGALY AND CYTOPENIA AFTER SURGICAL RESECTION AND CHEMOTHERAPY FOR COLORECTAL CANCER
(Abstract release date: 05/21/15)
EHA Library. Haas M. 06/12/15; 102943; PB1956
Disclosure(s): Practice for Hematology, Oncology and Palliative Care, Landshut, Germany
Michael Haas
Contributions
Contributions
Abstract
Abstract: PB1956
Type: Publication Only
Background
Hematology and oncology are increasingly becoming different specializations with own experts in their fields.
Aims
The current case from a rural oncologic practice in Germany shows an interesting cross-link between surgery, oncology and hematology.
Methods
A 38 year old woman underwent R0 resection of an adenocarcinoma of the ascending colon in 2001. Afterwards she was treated with 4 cycles of adjuvant chemotherapy with 5-fluorouracil/folinic acid/oxaliplatin. In 2005 recurrent disease with liver metastasis in the right liver lobe was diagnosed and was treated by a right hemihepatectomy. One year after the partial liver resection, a splenomegaly of 18cm x 5cm became evident, but did not cause any symptoms. The blood count then showed a slight tri-cytopenia with leucocytes 2.8 G/L, hemoglobin 11.3 g/dl and thrombocytes 85 G/L, which was interpreted as associated with previous chemotherapy. In frequent follow-up visits, there has been no sign of relapse of colorectal cancer up to now. The splenomegaly remained constant with recovered values for leucocytes and persistent thrombocytopenia around 100G/L. The patient was fully active without any problems due to splenomegaly. In 2013, the patient increasingly suffered from left-sided abdominal pain and fatigue, the spleen then was 20cm in size. Thrombocyte count had occasionally dropped below 50 G/L. Bone-marrow puncture was performed showing no signs of dysplastic syndrome or other malignancy. In August 2014, the spleen was 23 cm in longest diameter. A CT-scan showed signs of portal hypertension with pronounced collaterals, possibly due to constriction of the inferior vena cava and/or left hepatic vein, as a potential complication of the liver-resection in 2005. A gastroscopy confirmed oesophageal varices. The patient was transferred to a university hospital for further diagnostics and potential placement of a portosystemic shunt. Left hepatic vein stenosis could not be substantiated by venous catheter pressure measurements. As a definite reason for portal hypertension was not clear with no evidence for liver cirrhosis or fibrosis, the patient was advised for splenectomy for symptom relief.
Results
To avoid splenectomy, as preferred by the patient and the treating hemato-oncologist, the case was again discussed with the surgeon. It was concluded to initially perform a side-to-side spleno-renal shunt. After constructing the shunt, a significant reduction of blood-flow through the portal vein directly after surgery was observed. Only three months after the intervention, the spleen had shrunk from 24cm to 16cm accompanied by an increase in thrombocytes above 100 G/L and significant improvement of symptoms.
Summary
Splenectomy could finally be avoided and the patient showed a significant improvement in symptoms after construction of the shunt. The current case illustrates the necessity of close networking between different disciplines and especially the treating physicians in rural areas and specialists at highly specialized centers.
Keyword(s): Spleen, Thrombocytopenia
Session topic: Publication Only
Type: Publication Only
Background
Hematology and oncology are increasingly becoming different specializations with own experts in their fields.
Aims
The current case from a rural oncologic practice in Germany shows an interesting cross-link between surgery, oncology and hematology.
Methods
A 38 year old woman underwent R0 resection of an adenocarcinoma of the ascending colon in 2001. Afterwards she was treated with 4 cycles of adjuvant chemotherapy with 5-fluorouracil/folinic acid/oxaliplatin. In 2005 recurrent disease with liver metastasis in the right liver lobe was diagnosed and was treated by a right hemihepatectomy. One year after the partial liver resection, a splenomegaly of 18cm x 5cm became evident, but did not cause any symptoms. The blood count then showed a slight tri-cytopenia with leucocytes 2.8 G/L, hemoglobin 11.3 g/dl and thrombocytes 85 G/L, which was interpreted as associated with previous chemotherapy. In frequent follow-up visits, there has been no sign of relapse of colorectal cancer up to now. The splenomegaly remained constant with recovered values for leucocytes and persistent thrombocytopenia around 100G/L. The patient was fully active without any problems due to splenomegaly. In 2013, the patient increasingly suffered from left-sided abdominal pain and fatigue, the spleen then was 20cm in size. Thrombocyte count had occasionally dropped below 50 G/L. Bone-marrow puncture was performed showing no signs of dysplastic syndrome or other malignancy. In August 2014, the spleen was 23 cm in longest diameter. A CT-scan showed signs of portal hypertension with pronounced collaterals, possibly due to constriction of the inferior vena cava and/or left hepatic vein, as a potential complication of the liver-resection in 2005. A gastroscopy confirmed oesophageal varices. The patient was transferred to a university hospital for further diagnostics and potential placement of a portosystemic shunt. Left hepatic vein stenosis could not be substantiated by venous catheter pressure measurements. As a definite reason for portal hypertension was not clear with no evidence for liver cirrhosis or fibrosis, the patient was advised for splenectomy for symptom relief.
Results
To avoid splenectomy, as preferred by the patient and the treating hemato-oncologist, the case was again discussed with the surgeon. It was concluded to initially perform a side-to-side spleno-renal shunt. After constructing the shunt, a significant reduction of blood-flow through the portal vein directly after surgery was observed. Only three months after the intervention, the spleen had shrunk from 24cm to 16cm accompanied by an increase in thrombocytes above 100 G/L and significant improvement of symptoms.
Summary
Splenectomy could finally be avoided and the patient showed a significant improvement in symptoms after construction of the shunt. The current case illustrates the necessity of close networking between different disciplines and especially the treating physicians in rural areas and specialists at highly specialized centers.
Keyword(s): Spleen, Thrombocytopenia
Session topic: Publication Only
Abstract: PB1956
Type: Publication Only
Background
Hematology and oncology are increasingly becoming different specializations with own experts in their fields.
Aims
The current case from a rural oncologic practice in Germany shows an interesting cross-link between surgery, oncology and hematology.
Methods
A 38 year old woman underwent R0 resection of an adenocarcinoma of the ascending colon in 2001. Afterwards she was treated with 4 cycles of adjuvant chemotherapy with 5-fluorouracil/folinic acid/oxaliplatin. In 2005 recurrent disease with liver metastasis in the right liver lobe was diagnosed and was treated by a right hemihepatectomy. One year after the partial liver resection, a splenomegaly of 18cm x 5cm became evident, but did not cause any symptoms. The blood count then showed a slight tri-cytopenia with leucocytes 2.8 G/L, hemoglobin 11.3 g/dl and thrombocytes 85 G/L, which was interpreted as associated with previous chemotherapy. In frequent follow-up visits, there has been no sign of relapse of colorectal cancer up to now. The splenomegaly remained constant with recovered values for leucocytes and persistent thrombocytopenia around 100G/L. The patient was fully active without any problems due to splenomegaly. In 2013, the patient increasingly suffered from left-sided abdominal pain and fatigue, the spleen then was 20cm in size. Thrombocyte count had occasionally dropped below 50 G/L. Bone-marrow puncture was performed showing no signs of dysplastic syndrome or other malignancy. In August 2014, the spleen was 23 cm in longest diameter. A CT-scan showed signs of portal hypertension with pronounced collaterals, possibly due to constriction of the inferior vena cava and/or left hepatic vein, as a potential complication of the liver-resection in 2005. A gastroscopy confirmed oesophageal varices. The patient was transferred to a university hospital for further diagnostics and potential placement of a portosystemic shunt. Left hepatic vein stenosis could not be substantiated by venous catheter pressure measurements. As a definite reason for portal hypertension was not clear with no evidence for liver cirrhosis or fibrosis, the patient was advised for splenectomy for symptom relief.
Results
To avoid splenectomy, as preferred by the patient and the treating hemato-oncologist, the case was again discussed with the surgeon. It was concluded to initially perform a side-to-side spleno-renal shunt. After constructing the shunt, a significant reduction of blood-flow through the portal vein directly after surgery was observed. Only three months after the intervention, the spleen had shrunk from 24cm to 16cm accompanied by an increase in thrombocytes above 100 G/L and significant improvement of symptoms.
Summary
Splenectomy could finally be avoided and the patient showed a significant improvement in symptoms after construction of the shunt. The current case illustrates the necessity of close networking between different disciplines and especially the treating physicians in rural areas and specialists at highly specialized centers.
Keyword(s): Spleen, Thrombocytopenia
Session topic: Publication Only
Type: Publication Only
Background
Hematology and oncology are increasingly becoming different specializations with own experts in their fields.
Aims
The current case from a rural oncologic practice in Germany shows an interesting cross-link between surgery, oncology and hematology.
Methods
A 38 year old woman underwent R0 resection of an adenocarcinoma of the ascending colon in 2001. Afterwards she was treated with 4 cycles of adjuvant chemotherapy with 5-fluorouracil/folinic acid/oxaliplatin. In 2005 recurrent disease with liver metastasis in the right liver lobe was diagnosed and was treated by a right hemihepatectomy. One year after the partial liver resection, a splenomegaly of 18cm x 5cm became evident, but did not cause any symptoms. The blood count then showed a slight tri-cytopenia with leucocytes 2.8 G/L, hemoglobin 11.3 g/dl and thrombocytes 85 G/L, which was interpreted as associated with previous chemotherapy. In frequent follow-up visits, there has been no sign of relapse of colorectal cancer up to now. The splenomegaly remained constant with recovered values for leucocytes and persistent thrombocytopenia around 100G/L. The patient was fully active without any problems due to splenomegaly. In 2013, the patient increasingly suffered from left-sided abdominal pain and fatigue, the spleen then was 20cm in size. Thrombocyte count had occasionally dropped below 50 G/L. Bone-marrow puncture was performed showing no signs of dysplastic syndrome or other malignancy. In August 2014, the spleen was 23 cm in longest diameter. A CT-scan showed signs of portal hypertension with pronounced collaterals, possibly due to constriction of the inferior vena cava and/or left hepatic vein, as a potential complication of the liver-resection in 2005. A gastroscopy confirmed oesophageal varices. The patient was transferred to a university hospital for further diagnostics and potential placement of a portosystemic shunt. Left hepatic vein stenosis could not be substantiated by venous catheter pressure measurements. As a definite reason for portal hypertension was not clear with no evidence for liver cirrhosis or fibrosis, the patient was advised for splenectomy for symptom relief.
Results
To avoid splenectomy, as preferred by the patient and the treating hemato-oncologist, the case was again discussed with the surgeon. It was concluded to initially perform a side-to-side spleno-renal shunt. After constructing the shunt, a significant reduction of blood-flow through the portal vein directly after surgery was observed. Only three months after the intervention, the spleen had shrunk from 24cm to 16cm accompanied by an increase in thrombocytes above 100 G/L and significant improvement of symptoms.
Summary
Splenectomy could finally be avoided and the patient showed a significant improvement in symptoms after construction of the shunt. The current case illustrates the necessity of close networking between different disciplines and especially the treating physicians in rural areas and specialists at highly specialized centers.
Keyword(s): Spleen, Thrombocytopenia
Session topic: Publication Only
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