Chinese Herbal Medicine-Induced Rapid Liver Cirrhosis: A Case Report

Introduction: Chinese herbal medicine (CHM) has been widely used by patients in China and results in unpredictable nephrotoxicity and hepatotoxicity effects. Case Presentation: We report the case of a postoperative 69-year-old female patient with ascending colon cancer who rapidly developed liver cirrhosis after 18 months of continued CHM administration. The patient underwent right hemicolectomy at the Fourth Hospital of Hebei Medical University in August 2019 due to ascending colon cancer; at that time, the patient had no signs of liver cirrhosis based on computed tomography (CT) and routine blood examination. Postoperatively, the patient continued CHM administration for 18 months. The patient then visited our hospital with complaints of jaundice, abdominal distension, and edema in both lower limbs. CT imaging showed cirrhosis of the liver, while gastroscopy showed mild esophageal varices. Blood examinations including routine blood, coagulation function, and liver function tests, and biomarkers of hepatic fibrosis also supported the diagnosis of liver cirrhosis. To the best of our knowledge, this is the first report of CHM-induced liver cirrhosis. Conclusions: CHM administration possibly induces rapid liver cirrhosis within 18 months.

Pathological Complete Response of Clinical T4b Ascending Colon Cancer after Preoperative Chemotherapy Using Pembrolizumab

Preoperative chemotherapy is efficacious in several cancers. However, it is not an established treatment for locally advanced colon cancer, particularly cases with microsatellite instability-high (MSI-H)/deficient mismatch repair. Herein, we report a case of pathological complete response of MSI-H clinical T4b ascending colon cancer to preoperative treatment with pembrolizumab. A 78-year-old man was diagnosed with ascending colon cancer that invaded into the iliacus muscle and enlarged regional lymph nodes. The tumor was classified as T4bN1bM0 stage IIIC according to the 8th Union for International Cancer Control guidelines, with MSI-H status. Based on our initial diagnosis, this tumor could not be resected completely. Thus, the patient underwent preoperative therapy with CAPOX (capecitabine and oxaliplatin combination) plus bevacizumab. After 4 cycles of preoperative CAPOX/bevacizumab, we observed tumor reduction corresponding to a partial response based on the Response Evaluation Criteria in Solid Tumors criteria. Nevertheless, tumor invasion of the iliacus muscle persisted. Since oxaliplatin-induced peripheral sensory neuropathy was observed, we discontinued treatment with oxaliplatin and changed the regimen to pembrolizumab in anticipation of the therapeutic effect of this immune checkpoint inhibitor against MSI-H tumors. After 2 cycles of therapy with pembrolizumab (200 mg/body on day 1 every 3 weeks), there was drastic tumor regression. In addition, computed tomography indicated that all lymph node metastases had disappeared. Therefore, the patient underwent laparoscopic right hemicolectomy with D3 lymph node dissection. Analysis of the resected specimen showed pathological complete response.

Mesothelial cyst of the spleen mimicking a metastasis: a case report

Mesothelial cyst of the spleen is a developmental disorder. Previous reports have elaborated on the radiological features of splenic mesothelial cysts as being unilocular with a smooth and well-defined margin. However, due to its rarity, it is unclear whether these characteristics are representative and specific for the diagnosis of mesothelial cysts. Herein, this case report presents an atypical case of splenic mesothelial cyst mimicking a malignant tumour, especially splenic metastasis in a 66-year-old woman with ascending colon cancer. Due to an overlapping imaging finding of hypodense splenic lesions, and considering the clinical history, a mesothelial cyst that developed as a multilocular hypodense mass from an ill-defined small nodule was inevitably misdiagnosed as metastasis. Although rare, it is important to consider the possibility of mesothelial cyst in a patient with multilocular hypodense lesions of the spleen.

Germline deletion of chromosome 2p16-21 associated with Lynch syndrome

We identified a Japanese patient with Lynch syndrome with a novel large germline deletion of chromosome 2p16-21, including the EPCAM, MSH2, and KCNK12 genes. The proband was a 46-year-old man with ascending colon cancer. The clinical significance of germline KCNK12 gene deletion, which encodes one of the subfamilies of two-pore-domain potassium channels, is still unknown.