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1
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Wada Y, Matsugaki S, Nagao Y, Taniwaki S, Okuda K, Morimitsu Y. Hematogenous metastasis to the colon from hepatocellular carcinoma: A case report. Int J Surg Case Rep 2025; 126:110491. [PMID: 39662369 PMCID: PMC11697117 DOI: 10.1016/j.ijscr.2024.110491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 10/16/2024] [Accepted: 10/18/2024] [Indexed: 12/13/2024] Open
Abstract
Introduction and importance: Most extrahepatic metastases of hepatocellular carcinoma (HCC) are to the lungs and bones, metastases to the colon are rare. In the present study, we experienced a case of metastasis to the ascending colon during repeated treatment for HCC. Case Presentation: A 63-year-old man was diagnosed with multiple HCCs (T4N0M0 stage IIIB) associated with portal vein invasion. Transcatheter arterial chemoembolization (TACE), transarterial infusion (TAI) and radiofrequency ablation (RFA) were performed, and partial response was achieved, but the main nodule at S6 lesion subsequently recurred to protrude outside of the liver. A partial hepatic S6 resection was performed for local control 1.5 years after the initial treatment. IVR was then performed again, but approximately 8 months after hepatic resection, an abdominal computed toography (CT) showed a mass lesion in the ascending colon. After a total colonoscopy and biopsy, a diagnosis of colorectal metastasis of HCC was made. A right hemicolectomy was performed for local control. The patient had a good post-operative course, but developed liver failure due to rapid growth of the tumor thrombus of the main portal vein and died of primary disease approximately 3.5 months after the colon resection. Clinical Discussion: The metastasis of HCC to the colon is an extremely rare occurrence. Conclusion: One possible reason for this rarity is that portal vein tumor thrombosis (PVTT) results in colorectal metastasis via trans-portal retrograde metastasis.
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Affiliation(s)
- Yoshito Wada
- Department of Surgery, Tobata Kyoritsu Hospital, 2-5-1 Sawami, Tobata-ku, Kitakyushu city, Fukuoka Prefecture 804-0093, Japan.
| | - Satoru Matsugaki
- Department of Internal Medicine, Tobata Kyoritsu Hospital, 2-5-1 Sawami, Tobata-ku, Kitakyushu city, Fukuoka Prefecture 804-0093,Japan
| | - Yuichi Nagao
- Department of Surgery, Tobata Kyoritsu Hospital, 2-5-1 Sawami, Tobata-ku, Kitakyushu city, Fukuoka Prefecture 804-0093, Japan.
| | - Satoshi Taniwaki
- Department of Surgery, Tobata Kyoritsu Hospital, 2-5-1 Sawami, Tobata-ku, Kitakyushu city, Fukuoka Prefecture 804-0093, Japan.
| | - Koji Okuda
- Department of Surgery, Tobata Kyoritsu Hospital, 2-5-1 Sawami, Tobata-ku, Kitakyushu city, Fukuoka Prefecture 804-0093, Japan
| | - Yosuke Morimitsu
- Department of Pathology, Tobata Kyoritsu Hospital, 2-5-1 Sawami, Tobata-ku, Kitakyushu city, Fukuoka Prefecture 804-0093, Japan
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2
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Uchikoshi M, Ito T, Nakajima Y, Sugiura I, Uozumi S, Shimozuma Y, Sakaki M, Ohira Y, Yamochi T, Yoshida H. Simultaneous gastric, pancreatic, and renal metastasis from poorly differentiated hepatocellular carcinoma. Clin J Gastroenterol 2024; 17:497-504. [PMID: 38451411 PMCID: PMC11127805 DOI: 10.1007/s12328-024-01935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024]
Abstract
Common extrahepatic metastasis sites of hepatocellular carcinoma (HCC) are the lungs, adrenal glands, and bones. Herein, we report a rare case of metastatic gastric, pancreatic, and renal tumors from HCC simultaneously, and review the relevant literature. A 75-year-old woman presented with right hypochondralgia, appetite loss, and weight loss. Computed tomography revealed suspected metastatic liver, lung, and renal tumors. A blood test revealed a leukocyte count of 26,210/μL and a high inflammatory reaction. As sepsis was suspected, the patient was referred to our hospital. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging revealed a hypovascular liver tumor that was suspected to be metastatic. Upper gastrointestinal endoscopy revealed two suspected metastatic gastric tumors. Liver and gastric tumor biopsies revealed poor carcinoma in both. The patient's condition gradually worsened and she died on day 8 of the illness. Based on autopsy findings, the patient was finally diagnosed with metastatic gastric and renal tumors originating from HCC. Additionally, a metastatic pancreatic tumor originating from the HCC was identified during autopsy. The pathological diagnosis of the pulmonary lesion was primary lung adenocarcinoma. In conclusion, HCC should be suspected in cases with multiple metastases of unknown primary lesions.
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Affiliation(s)
- Manabu Uchikoshi
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan.
| | - Takayoshi Ito
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Kotoku, Tokyo, 135-8577, Japan
| | - Yoko Nakajima
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Ikuya Sugiura
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Shoujirou Uozumi
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Yuu Shimozuma
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Masashi Sakaki
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Yasuyuki Ohira
- Department of Pathology and Laboratory Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Toshiko Yamochi
- Department of Pathology and Laboratory Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Hitoshi Yoshida
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
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3
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Tseng HP, Chen WC, Yu HC, Tsay FW, Chen YH, Wu CC, Hsu CW. Full-thickness resection of colonic metastasis using endo-laparoscopic approach-A video vignette. Colorectal Dis 2022; 24:1633-1634. [PMID: 35818820 DOI: 10.1111/codi.16256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Hsin-Ping Tseng
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chi Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsien-Chung Yu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Feng-Woei Tsay
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Hsun Chen
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chien Wu
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Wen Hsu
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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4
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Muacevic A, Adler JR, Tancredi I, Tannouri F, Verset G. Duodenal Hemorrhage Due to an Invasive Hepatocellular Carcinoma Controlled by Transarterial Embolization. Cureus 2022; 14:e32046. [PMID: 36600825 PMCID: PMC9800851 DOI: 10.7759/cureus.32046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Upper gastrointestinal (GI) bleeding due to duodenal invasion is a very unusual presentation revealing the initial diagnosis of hepatocellular carcinoma (HCC), especially in patients without cirrhosis. No clear recommendations are available in this setting. A 68-year-old man was admitted to the emergency department with melena. The esophagogastroduodenoscopy (EGD) revealed an oozing hemorrhagic ulcer of the duodenal bulb (Forrest I b) secondary to an invasive, undetermined bulky liver mass that was biopsied. The histopathological examination confirmed an HCC. The patient was started on chemotherapy (Gemcitabine and Oxaliplatin) with good initial response. Nevertheless, after eight months of treatment, there was a recurrence of the ulcer bleeding and a disease progression was identified. Selective transarterial embolization (TAE) was used to control the duodenal bleeding, permitting the patient to receive immunotherapy with a long-lasting control of the disease. Our case report suggests that selective TAE is a therapeutic option that can be used to stop GI bleeding due to invasive HCC in order to allow oncological treatment.
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Hepatocellular Carcinoma with Gastrointestinal Involvement: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12051270. [PMID: 35626424 PMCID: PMC9140172 DOI: 10.3390/diagnostics12051270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/15/2022] [Accepted: 05/15/2022] [Indexed: 01/27/2023] Open
Abstract
In this paper, we aimed to evaluate clinical and imagistic features, and also to provide a diagnostic algorithm for patients presenting with gastrointestinal involvement from hepatocellular carcinoma (HCC). We conducted a systematic search on the PubMed, Scopus and Web of Science databases to identify and collect papers oncases of HCC with gastrointestinal involvement. This search was last updated on 29 April 2022. One hundred and twenty-three articles were included, corresponding to 197 patients. The majority of the patients were male (87.30%), with a mean age of 61.21 years old. The analysis showed large HCCs located mainly in the right hepatic lobe, and highly elevated alfa-fetoprotein (mean = 15,366.18 ng/mL). The most frequent etiological factor was hepatitis B virus (38.57%). Portal vein thrombosis was present in 27.91% of cases. HCC was previously treated in most cases by transarterial chemoembolization (32.99%) and surgical resection (28.93%). Gastrointestinal lesions, developed mainly through direct invasion and hematogenous routes, were predominantly detected in the stomach and duodenum in equal measure—27.91%. Gastrointestinal bleeding was the most common presentation (49.74%). The main diagnostic tools were esophagogastroduodenoscopy (EGD) and computed tomography. The mean survival time was 7.30 months. Gastrointestinal involvement in HCC should be included in the differential diagnosis of patients with underlying HCC and gastrointestinal manifestations or pathological findings in EGD.
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6
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De Somer T, Vanderstraeten E, Bouderez V, Monsaert E, Van Steenkiste C. Resolution of a hepatoduodenal fistula after nivolumab treatment in a patient with hepatocellular carcinoma: challenges in immunotherapy. Acta Clin Belg 2022; 77:108-112. [PMID: 32529925 DOI: 10.1080/17843286.2020.1778346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hepatocellular carcinoma is the fourth leading cause of cancer-related death worldwide, with limited treatment options for patients with advanced hepatocellular carcinoma. Beyond standard systemic therapy with multikinase inhibitors, recent studies demonstrate the potential for a robust and durable response with immune checkpoint inhibition in subsets of patients with hepatocellular carcinoma.We present a case of an 83-year-old male patient with the diagnosis of a multifocal hepatocellular carcinoma. A hepatoduodenal fistula developed under treatment with sorafenib which necessitated treatment interruption. Therefore, a switch to second line therapy with immunotherapy nivolumab was made and supportive enteral nutrition was started. This led to a spectacular oncological response, with complete resolution of the hepatoduodenal fistula. To our knowledge this is the first case which describes the involution of a fistula in a hepatocellular carcinoma under treatment with nivolumab.
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Affiliation(s)
- Thomas De Somer
- Department of Gastroenterology and Hepatology, Maria Middelares Hospital, Ghent, Belgium
| | - Erik Vanderstraeten
- Department of Gastroenterology and Hepatology, Maria Middelares Hospital, Ghent, Belgium
| | - Vincent Bouderez
- Department of Gastroenterology and Hepatology, Maria Middelares Hospital, Ghent, Belgium
| | - Els Monsaert
- Department of Gastroenterology and Hepatology, Maria Middelares Hospital, Ghent, Belgium
| | - Christophe Van Steenkiste
- Department of Gastroenterology and Hepatology, Maria Middelares Hospital, Ghent, Belgium
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Edegem, Belgium
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7
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8
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Miyauchi W, Yamamoto M, Masahiro M, Shishido Y, Miyatani K, Matsunaga T, Sakamoto T, Fujiwara Y. Colonic metastasis of hepatocellular carcinoma with repeated retroperitoneal bleeding: a case report. Surg Case Rep 2021; 7:261. [PMID: 34921642 PMCID: PMC8684546 DOI: 10.1186/s40792-021-01349-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colonic metastasis is uncommon in patients with hepatocellular carcinoma (HCC). In the past, extrahepatic metastasis of HCC was not treated aggressively because of its poor prognosis. Herein, we describe the case of a patient with HCC who survived for 30 months following resection of a metastatic tumor in the ascending colon. CASE PRESENTATION An 80-year-old man presented at our hospital with symptoms of abdominal pain on the right side and fever. He had undergone transcatheter arterial chemoembolization and posterior segment resection of the liver because of HCC, followed by radiofrequency ablation for a recurrent intrahepatic lesion 5 and 3 years, respectively, prior to the visit. He was diagnosed with retroperitoneal hematoma, which was thought to be associated with diverticulitis and an extramural tumor in the ascending colon. A definitive diagnosis could not be reached; however, a right hemicolectomy of the colon was performed because of progression to anemia. A pathological examination revealed a metastatic tumor in the ascending colon extending from the subserosal layer to the muscularis propria layer. The patient was treated with lenvatinib after surgery, but presented with intrahepatic recurrence, lymph node metastasis, and peritoneal dissemination metastasis 15 months later. The progression of the disease could not be controlled and his postoperative survival time was 30 months. CONCLUSION Resection of metastasis of HCC might contribute to prolonged survival in cases, where radical resection is possible.
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Affiliation(s)
- Wataru Miyauchi
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Makinoya Masahiro
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
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9
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Miwa T, Kochi T, Watanabe K, Hanai T, Imai K, Suetsugu A, Takai K, Shiraki M, Katsumura N, Shimizu M. Recurrent hepatogastric fistula during lenvatinib therapy for advanced hepatocellular carcinoma managed by over-the-scope clip closure: a case report. J Rural Med 2021; 16:102-110. [PMID: 33833836 PMCID: PMC8016677 DOI: 10.2185/jrm.2020-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022] Open
Abstract
Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC). Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence. Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure. Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology, Chuno Kosei Hospital, Japan
| | - Takahiro Kochi
- Department of Gastroenterology, Chuno Kosei Hospital, Japan
| | | | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan.,Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan
| | - Atsushi Suetsugu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan.,Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Japan
| | - Makoto Shiraki
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan
| | | | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan
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10
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Abouzied MM, Fathala A, AlMuhaideb A, Almanea H, Al-Sugair AS, AlSkaff R, Al-Qahtani MH. Gastric wall metastases from hepatocellular carcinoma: case report and review of the literature. Radiol Case Rep 2021; 16:550-554. [PMID: 33384755 PMCID: PMC7770481 DOI: 10.1016/j.radcr.2020.12.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 01/10/2023] Open
Abstract
A 69-year-old male patient who had a history of well-differentiated hepatocellular carcinoma (HCC) post right hepatectomy presented a year later with iron-deficiency anemia. His anemia work-up included upper endoscopy that revealed multiple gastric polyp a biopsy from the largest demonstrated metastatic hepatocellular carcinoma. His magnetic resonance imaging (MRI) showed a gastric "polyp" without evidence of local HCC recurrence within the liver. His subsequent dual imaging with Choline/fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) confirmed the gastric metastases and in addition revealed other sites of unexpected metastatic disease in the right adrenal and the bone that was asymptomatic. Patient was started on sorafenib and currently he is alive one-and-half-year postdetection of his metastatic disease under palliative care. This case showed that the possibility of gastric metastases should be kept in mind when confronted with anemia in HCC patient and also highlight the complementary role of molecular imaging modality along with MRI in the metastatic work-up for hepatocellular carcinoma postcurative resection.
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Affiliation(s)
- Moheieldin M Abouzied
- Department of Radiology, Medical Imaging Service, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Fathala
- Department of Radiology, Medical Imaging Service, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmad AlMuhaideb
- Department of Radiology, Medical Imaging Service, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hadeel Almanea
- Pathology and Laboratory Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulaziz S Al-Sugair
- Department of Radiology, Medical Imaging Service, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Rasha AlSkaff
- Department of Radiology, Medical Imaging Service, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed H Al-Qahtani
- Cyclotron and Radiopharmaceuticals Department, King Faisal Specialist Hospital and Research Centre, MBC#28, P.O. Box 3354, Riyadh 11211, Saudi Arabia
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11
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Mashiko T, Masuoka Y, Nakano A, Tsuruya K, Hirose S, Hirabayashi K, Kagawa T, Nakagohri T. Intussusception due to hematogenous metastasis of hepatocellular carcinoma to the small intestine: A case report. World J Gastroenterol 2020; 26:6698-6705. [PMID: 33268957 PMCID: PMC7673968 DOI: 10.3748/wjg.v26.i42.6698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma (HCC) are the lungs, bones, adrenal glands, and regional lymph nodes. Hematogenous metastasis to the gastrointestinal (GI) tract is a rare condition in patients with HCC, and the prognosis is usually poor. We report, herein, an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy. CASE SUMMARY The patient was a 71-year-old man with a history of chronic hepatitis B, who had undergone three surgeries for HCC. He was treated with sorafenib for peritoneal metastases of HCC. He was admitted to our hospital with chief complaints of abdominal pain and vomiting. Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor, presenting with intussusception and small bowel obstruction. Conservative treatment was started, but due to repeated exacerbation of symptoms, surgery was planned on the 28th d of hospitalization. Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed. On histological examination, tumor cells were not observed on the serosal surface, but intravascular invasion of tumor cells was seen. Immunohistochemistry was positive for immunohistochemical markers, and a diagnosis of hematogenous metastasis of HCC to the ileum was made. He remains alive 82 mo after the first surgery. CONCLUSION Prognosis of HCC patients with GI tract metastasis is usually poor, but in some cases, multidisciplinary therapy may prolong survival.
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Affiliation(s)
- Taro Mashiko
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Yoshihito Masuoka
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Akira Nakano
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Kota Tsuruya
- Department of Gastroenterology, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Shunji Hirose
- Department of Gastroenterology, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Kenichi Hirabayashi
- Department of Pathology, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Tatehiro Kagawa
- Department of Gastroenterology, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Toshio Nakagohri
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
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12
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Yu YM, Cao YS, Wu Z, Huang R, Shen ZL. Colon metastasis from hepatocellular carcinoma: a case report and literature review. World J Surg Oncol 2020; 18:189. [PMID: 32723336 PMCID: PMC7389379 DOI: 10.1186/s12957-020-01960-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/17/2020] [Indexed: 01/10/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a malignant tumor with frequent intrahepatic metastases; extrahepatic metastases are not rare but less frequent compared to intrahepatic ones. The most frequent sites of extrahepatic metastases are the lungs, followed by the lymph nodes, bones, and adrenal glands. Case report covering gastrointestinal (GI) tract involvement from HCC is limited. Case presentation A 60-year-old man was referred to us in May 2019 with a diagnosis of sigmoid colon tumor. The patient had a history of HCC and had received two stages of open resections for the primary and the abdominal metastasis successively and many times of transcatheter arterial chemoembolization (TACE). The sigmoid colon tumor received Hartmann procedure after abdominal enhanced computerized tomography (CT) scan and colonoscopy, while postoperative pathology and immunohistochemistry identified it as extrahepatic colonic metastasis from HCC. Conclusions The ratio of extrahepatic metastasis to the digestive tract was very low, and the majority was upper gastrointestinal involvement because of direct invasion or intraperitoneal implantation. TACE may be the risk factor of retrograde hematogenous metastasis to the downstream colon. Keywords Hepatocellular carcinoma; Extrahepatic metastases; Colon metastasis; Transcatheter arterial chemoembolization
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Affiliation(s)
- Yong-Ming Yu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, 315000, China
| | - Yi-Sheng Cao
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, China. .,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, China. .,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, 315000, China.
| | - Zhou Wu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, 315000, China
| | - Rong Huang
- Ningbo Pathological Diagnosis Center, Ningbo, 315000, China
| | - Zhong-Lei Shen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, 315000, China
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13
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Pham BV, Phan HH, Ngo LL, Nguyen HTT, Le KV, Dinh TC, Bac ND. A Rare Colonic Metastasis Case from Hepatocellular Carcinoma. Open Access Maced J Med Sci 2019; 7:4368-4371. [PMID: 32215096 PMCID: PMC7084010 DOI: 10.3889/oamjms.2019.837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hepatocellularcarcinoma (HCC) metastasis include intrahepatic and extrahepatic metastasis. Similar to intrahepatic metastasis, extrahepatic metastases are not unusual in cases with HCC. However, colonic metastasis is infrequent. CASE REPORT We describe a clinical case, he was diagnosed with HCC a year ago, treated with TACE (transarterialchemoembolisation), re-examined with abdominal pain and defecation disorder. The tests such as CT scan, colorectal endoscopy, fine needle aspiration (FNA) revealed secondary metastatic lesion of HCC in sigmoid colon. This is the first gastrointestinal (GI) tract metastatic we have encountered. CONCLUSION HCC metastases of the colon are rare, especially cases of hematogenous spread. The prognosis of these patients is often very critical. Indications for surgical removal of the lesion may be used if the general situation of patient is acceptable.
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Affiliation(s)
| | | | - Lam Le Ngo
- Vietnam National Cancer Hospital, Hanoi, Vietnam
| | | | - Ky Van Le
- Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Thien Chu Dinh
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Nguyen Duy Bac
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
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14
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Imai M, Ishikawa T, Okoshi M, Tomiyoshi K, Kojima Y, Horigome R, Nozawa Y, Sano T, Iwanaga A, Honma T, Nemoto T, Takeda K, Nishikura K, Ishihara N, Yoshida T. Hemorrhagic Gastric Metastasis from Hepatocellular Carcinoma Successfully Treated Using Coil Embolization of the Left Gastric Artery. Intern Med 2019; 58:2179-2183. [PMID: 30996163 PMCID: PMC6709331 DOI: 10.2169/internalmedicine.2172-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/20/2019] [Indexed: 01/10/2023] Open
Abstract
A 62-year-old man initially underwent transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma (HCC). One year after the initial treatment, he developed anemia. Upper gastrointestinal endoscopy revealed irregularly elevated tumors in the lower anterior gastric body, which were diagnosed to be metastasis from HCC. Left gastric artery coil embolization was performed to prevent sustained bleeding, and his anemia partially improved. In addition to direct invasion, hematogenous metastasis to the stomach from HCC is possible and therefore should be considered during treatment. Transcatheter arterial embolization for gastric metastasis is an effective treatment method which achieves a good degree of hemostasis in patients without any surgical indications.
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Affiliation(s)
- Michitaka Imai
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Marina Okoshi
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Kei Tomiyoshi
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Yuichi Kojima
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Ryoko Horigome
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Yujiro Nozawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Tomoe Sano
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Akito Iwanaga
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Takeo Nemoto
- Department of Radiology, Saiseikai Niigata Daini Hospital, Japan
| | - Keiko Takeda
- Department of Radiology, Saiseikai Niigata Daini Hospital, Japan
| | - Ken Nishikura
- Department of Pathology, Saiseikai Niigata Daini Hospital, Japan
| | - Noriko Ishihara
- Department of Pathology, Saiseikai Niigata Daini Hospital, Japan
| | - Toshiaki Yoshida
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
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15
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Ito T, Hirose T, Matsumoto A, Yogo A, Okuno T, Doi R. Hepatocellular carcinoma with duodenal invasion resected subsequent to multimodal therapies: A case report. Int J Surg Case Rep 2019; 60:348-352. [PMID: 31284223 PMCID: PMC6614111 DOI: 10.1016/j.ijscr.2019.06.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) with duodenal invasion is a very rare occurrence. Aggravated disease condition of HCC with duodenal invasion usually makes surgical treatment not advisable. We present the first case of HCC with duodenal invasion resected following a multimodal therapy that included sorafenib. Partial hepatectomy in conjunction with partial duodenectomy was selected to lessen surgical stress. Surgical resection should be taken into consideration as a therapeutic choice even in progressive HCC disease condition. Introduction Gastrointestinal (GI) involvement in hepatocellular carcinoma (HCC) is uncommon. In particular, HCC with duodenal invasion is known to be a rare condition. In such cases, surgical indication has been generally negative except in few reported cases. To our knowledge, this report describes the first case of HCC with duodenal invasion, resected by hepatectomy accompanied by pancreas-preserving partial duodenectomy (HPPD) following multimodal therapies including systemic sorafenib administration. Case presentation A 65-year-old man had been repeatedly treated for multiple HCCs by transarterial chemoembolization (TACE) and sorafenib. However, the main tumor formerly ruptured began to involve his duodenum, causing GI bleeding. The collateral vessels from the pancreatic and omental branches entered the tumor and nullified the transarterial hemostatic embolization. Hence, HPPD was performed to preserve the major Vater papilla. Histopathological examination revealed poorly-to -moderately differentiated HCC cells invading the duodenum. Discussion and conclusion HPPD treatment successfully removed HCC with duodenal invasion achieving viable tumor clearance status (R0). We underline the importance of achieving viable tumor clearance status at any time during the treatment course of patients with advanced HCC as this approach may be the only approach to enable HCC patients with duodenal invasion to resume a healthy life.
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Affiliation(s)
- Takashi Ito
- Department of Surgery, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan.
| | - Tetsuro Hirose
- Department of Surgery, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
| | - Atsushi Matsumoto
- Department of Gastroenterology, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
| | - Akitada Yogo
- Department of Surgery, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
| | - Tomoko Okuno
- Department of Pathology, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
| | - Ryuichiro Doi
- Department of Surgery, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
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16
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Soni A, Malhi NS. Lower Gastrointestinal Bleeding: Liver Rams into Gut! GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:218-220. [PMID: 31192293 DOI: 10.1159/000488605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/06/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Amit Soni
- Department of Gastroenterology and Liver Disease, SPS Hospital, Ludhiana, India
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17
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Shelat VG, Giron DM, Oo AM. Acute haemoperitoneum due to small bowel metastases from hepatocellular carcinoma in a long term survivor following previous rupture. Ann Hepatobiliary Pancreat Surg 2018; 22:416-418. [PMID: 30588535 PMCID: PMC6295373 DOI: 10.14701/ahbps.2018.22.4.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 02/05/2023] Open
Abstract
We report a 75-year old patient, presenting with acute abdomen and hemorrhagic shock. He provided history of right hemihepatectomy performed 5 years ago, for ruptured hepatocellular carcinoma on a background of Hepatitis B virus associated liver cirrhosis. A computerized tomography scan showed 5 cm-sized mass exophytic lesion, in the small bowel with haemoperitoneum. An emergency laparotomy and small bowel resection, with primary anastomosis was performed. Histology showed Hep Par 1 stain reactive cells, on the serosal surface of the small bowel. A final diagnosis of metastatic hepatocellular carcinoma was made.
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Affiliation(s)
- Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Aung Myint Oo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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18
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Metastasis of Hepatocellular Carcinoma to the Esophagus: Case Report and Review. Case Rep Surg 2018; 2018:8685371. [PMID: 30319830 PMCID: PMC6167577 DOI: 10.1155/2018/8685371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/04/2018] [Accepted: 09/02/2018] [Indexed: 02/07/2023] Open
Abstract
A follow-up endoscopy in a 71-year-old Japanese man who had undergone a left lateral segmentectomy for HCC two years ago revealed an approximately 2 cm in diameter pedunculated polypoid mass in the middle part of the thoracic esophagus. Immunohistochemical staining of the endoscopic biopsy revealed a metastatic HCC esophageal tumor. As the patient's disease could be radically removed by preoperative examinations, we resected the metastatic esophageal tumor via right thoracotomy and esophagogastrostomy reconstruction. Histological examination of the resected specimen revealed that the esophageal tumor was compatible with a HCC metastasis. This is an extremely rare case of a solitary metastasis to the esophagus from HCC in the literature.
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19
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Kasi M, Rashid S, Wallace SAJ, Sujendran V, Griffiths B, Butler A, Gibbs P, Sreedharan L, Zaitoun AM, Venkatachalapathy S, James MW, Aithal GP. Seeding of hepatocellular carcinoma into the stomach wall following endoscopic ultrasound and fine-needle aspiration biopsy. Oxf Med Case Reports 2018; 2018:omy039. [PMID: 30046450 PMCID: PMC6053806 DOI: 10.1093/omcr/omy039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/26/2018] [Accepted: 06/01/2018] [Indexed: 01/10/2023] Open
Abstract
Delayed gastrointestinal metastasis is a rare complication of hepatocellular carcinoma (HCC). We present the case of a patient who presented with melaena and microcytic anaemia 6 years after receiving an orthotopic liver transplant for hepatitis B-induced HCC. Oesophagogastroduodenoscopy revealed a fungating gastric mass at the lesser curve and histology from biopsies confirmed metastatic recurrence of HCC in the stomach. The route of metastasis is likely due to iatrogenic seeding of tumour cells during pre-transplant endoscopic ultrasound (EUS) and fine needle aspiration (FNA) biopsy. Subsequent positron emission tomography and magnetic resonance imaging failed to reveal further metastatic disease and the patient was managed with a total gastrectomy. This is the first reported description in the literature of needle-track metastasis in the stomach due to liver EUS-FNA for HCC.
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Affiliation(s)
- M Kasi
- Nottingham Digestive Diseases Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Samin Rashid
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - S A J Wallace
- Division of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Vijayendran Sujendran
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Bill Griffiths
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Andrew Butler
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Paul Gibbs
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Loveena Sreedharan
- Liver Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - A M Zaitoun
- Division of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Venkatachalapathy
- Nottingham Digestive Diseases Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M W James
- Nottingham Digestive Diseases Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - G P Aithal
- Nottingham Digestive Diseases Centre (NDDC) and NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University and Nottingham University Hospitals NHS Trust, Nottingham, UK
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20
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Abstract
A 76-year-old man with hepatocellular carcinoma associated with alcoholic cirrhosis was hospitalized for lightheadedness and melena. He had undergone multiple surgeries and had been treated with transcatheter arterial chemoembolization and sorafenib. Neither upper nor lower gastrointestinal endoscopy detected the source of bleeding. Oral double-balloon enteroscopy revealed a mass lesion in the upper jejunum, 20 cm from the Treitz ligament on the anal side, which was identified as the source of bleeding. Subsequently, a biopsy was performed. A histopathological examination detected a hepatocellular carcinoma, and a final diagnosis of jejunal metastasis from hepatocellular carcinoma was established.
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Affiliation(s)
- Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | | | | | - Masakazu Nakano
- Department of Gastroenterology, Dokkyo Medical University, Japan
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21
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Nitipir C, Ginghina O, Popa L, Andrei F, Tudor N, Radu I, Iaciu C, Orlov C, Vasilescu F, Balalau C, Leon G, Negrei C, Barbu MA. A rare case of advanced lung cancer presenting as a symptomatic gastric tumor. Mol Clin Oncol 2018. [PMID: 29541469 DOI: 10.3892/mco.2018.1565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Although gastric metastases have been estimated to occur in less than 2% of cancer patients, an increased use of upper digestive tract endoscopy allows for a higher detection of secondary gastric tumors. We describe the case of a 66-year-old male patient presenting with mild pain in the sternum and upper abdominal area. Physical examination revealed a right parietal skull tumor, with no other significant clinical changes. Upon exclusion of an acute coronary syndrome, upper digestive tract endoscopy was performed, showing the presence of an ulcerated tumor located in the gastric fundus. Histopathologic examination of the biopsy sample and immunohistochemical tests suggested a pulmonary origin of the gastric tumor. Whole body computer tomography showed the presence of tumors in the gastric fundus, left lung, liver, kidneys, bones and brain. Transbronchial biopsy of the lung tumor certified the diagnosis of non-small cell lung cancer, with the same immunohistochemical profile as the gastric tumor. Hence, it was considered the origin of the metastases. Biopsy of the skull tumor also had the identical tumor histology. Whole brain radiotherapy was performed for the brain metastases and subsequent chemotherapy was administered. Although non-specific, gastrointestinal signs and symptoms occurring in lung cancer patients should alert the clinicians as to the possibility of gastrointestinal metastases and prompt endoscopic evaluation.
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Affiliation(s)
- Cornelia Nitipir
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Octav Ginghina
- Department of Surgery, 'Sf. Ioan' Clinical Emergency Hospital, Carol Davila University, Faculty of Dental Medicine, 042122 Bucharest, Romania
| | - Liliana Popa
- Department of Dermatology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Florin Andrei
- Department of Histopathology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Nicolaie Tudor
- Department of Gastroenterology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Irina Radu
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Cristian Iaciu
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Cristina Orlov
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Florina Vasilescu
- Department of Pathology, Emergency University Military Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 020021 Bucharest, Romania
| | - Cristian Balalau
- Department of Surgery, 'Sf. Pantelimon' Clinical Emergency Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 021659 Bucharest, Romania
| | - Grigoris Leon
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Medical School, 10679 Athens, Greece
| | - Carolina Negrei
- Department of Toxicology, Faculty of Pharmacy, 'Carol Davila' University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Maria Alexandra Barbu
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
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22
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Upper Gastrointestinal Bleed Due to Invasive Hepatocellular Carcinoma and Hepato-Gastric Fistula. J Clin Exp Hepatol 2018; 8:104-105. [PMID: 29743802 PMCID: PMC5938330 DOI: 10.1016/j.jceh.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 09/27/2017] [Indexed: 12/12/2022] Open
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23
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Piccirillo M, Granata V, Albino V, Palaia R, Setola SV, Petrillo A, Tatangelo F, Botti G, Foggia M, Izzo F. Can Hepatocellular Carcinoma (HCC) Produce Unconventional Metastases? Four Cases of Extrahepatic HCC. TUMORI JOURNAL 2018; 99:e19-23. [DOI: 10.1177/030089161309900127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aims and background Extrahepatic spread of hepatocellular carcinoma (HCC) diagnosed during the clinical course of the disease is not frequent; however, with the prolonged survival of HCC patients, the incidence of extrahepatic metastases seems to be increasing. Methods and study design We present four unusual cases of extrahepatic metastasis from HCC: the first concerns a patient who underwent a liver transplantation for HCC with cirrhosis and three years later developed metastases in the lung and the left orbit; the second is that of a patient who developed an extraperitoneal pararectal metastasis; in the third case a large osteolytic lesion developed on the left iliac bone, and in the fourth case we found an isolated metastasis in the left mandible. Results and conclusions These cases offer important information related to the unusual biology of isolated metastases from HCC after successful treatment of the primary cancer.
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Affiliation(s)
- Mauro Piccirillo
- Deparment of Surgical Oncology, Hepatobiliary Surgery UnitIstituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
| | - Vincenza Granata
- Department of Radiology Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
| | - Vittorio Albino
- Deparment of Surgical Oncology, Hepatobiliary Surgery UnitIstituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
| | - Raffaele Palaia
- Deparment of Surgical Oncology, Hepatobiliary Surgery UnitIstituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
| | - Sergio Venanzio Setola
- Department of Radiology Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
| | - Antonella Petrillo
- Department of Radiology Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
| | - Fabiana Tatangelo
- Department of Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
| | - Gerardo Botti
- Department of Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
| | - Margherita Foggia
- Deparment of Surgical Oncology, Hepatobiliary Surgery UnitIstituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
| | - Francesco Izzo
- Deparment of Surgical Oncology, Hepatobiliary Surgery UnitIstituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, “Fondazione G Pascale”, Naples, Italy
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24
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Nielsen JA, Putcha RV, Roberts CA. The Increasing Incidence of Remote Metastasis: A Case Report of Metastatic Hepatocellular Carcinoma to the Rectosigmoid. TUMORI JOURNAL 2018; 100:e31-4. [DOI: 10.1177/030089161410000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
As the fifth most common malignancy worldwide, survival rates of hepatocellular carcinoma (HCC) have only slightly improved over the years due to early-stage detection. HCC is well known to metastasize to the lung, lymph nodes, and musculoskeletal regions; however, only 0.5% to 6% of HCCs metastasize to the gastrointestinal tract. In the case described here, a CT scan and subsequent colonoscopy of a 51-year-old Asian male with a history of hepatitis B and HCC revealed a mass lesion of metastatic HCC 12 cm from the anal verge. Because metastatic HCC to the lower gastrointestinal tract has only recently been reported, it is speculated that the prolonged survival of patients is also increasing the incidence of extrahepatic metastasis, giving the disease greater opportunity to spread to more distant regions of the body. This case may be the farthest metastasis within the gastrointestinal tract to date.
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Affiliation(s)
| | | | - Cory A Roberts
- Division of Gastrointestinal Pathology, ProPath Services, LLP, Dallas, Texas, USA
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25
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Haruki K, Misawa T, Gocho T, Saito R, Shiba H, Akiba T, Yanaga K. Hepatocellular carcinoma with gastric metastasis treated by simultaneous hepatic and gastric resection: report of a case. Clin J Gastroenterol 2016; 9:319-23. [PMID: 27484064 DOI: 10.1007/s12328-016-0677-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/24/2016] [Indexed: 01/10/2023]
Abstract
Hepatocellular carcinoma (HCC) with gastric metastasis is extremely rare. There have been few reports on curative surgical resection for gastric metastasis of HCC. We herein report such a case successfully treated by simultaneous surgical resection. A 73-year-old male was admitted for evaluation and treatment of a liver tumor. Computed tomography showed an exophytic tumor of 170 mm in diameter located in the left lobe of the liver with poor delineation to the gastric wall. Upper gastrointestinal endoscopy revealed a submucosal tumor with ulceration in the antrum of the stomach. With a diagnosis of HCC with invasion to the gastric wall, an en bloc resection was planned, and the patient underwent laparotomy. The patients underwent left hemihepatectomy with partial resection of the stomach for adhesion and distal gastrectomy for the tumor. Pathological examination of the liver tumor revealed poorly differentiated HCC, and pathological diagnosis of the tumor in the submucosal and muscular layer of the stomach was compatible with metastasis from HCC, which was separate from the liver tumor. Therefore, we diagnosed the tumor as HCC with hematogenous gastric metastasis. The patient remains well with no evidence of tumor recurrence as of 13 months after resection.
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Affiliation(s)
- Koichiro Haruki
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan.
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Takeyuki Misawa
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takeshi Gocho
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryota Saito
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroaki Shiba
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tadashi Akiba
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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26
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Li L, Zhang WH, Meng FP, Ma XM, Shen LJ, Jin B, Li HW, Han J, Zhou GD, Liu SH. Gastric Metastasis of Hepatocellular Carcinoma With Gastrointestinal Bleeding After Liver Transplant: A Case Report. Transplant Proc 2016; 47:2544-7. [PMID: 26518968 DOI: 10.1016/j.transproceed.2015.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/02/2015] [Indexed: 01/20/2023]
Abstract
Gastrointestinal (GI) metastasis of hepatocellular carcinoma is very rare. This is the first report of post-transplantation gastric metastasis. A 43-year-old man with a history of hepatitis B-related hepatocellular carcinoma (HCC) in the right anterior segment of the liver received an orthotopic liver transplant. Three months after the transplantation, pulmonary metastasis was found by chest computed tomography, and he received 1 course of gamma knife treatment. He complained of melena with anemia 17 months post liver transplantation. Abdominal CT scan showed new occupying lesions in the liver and a mass in the stomach and around the spleen with embolus in the splenic vein. Endoscopy revealed a large irregular cauliflower-like mass in fundus with ulceration and bleeding on the surface. He received symptomatic treatment, but died of cancer-related bleeding 4 months later. GI bleeding may due to gastric metastasis after liver transplantation.
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Affiliation(s)
- L Li
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - W H Zhang
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - F P Meng
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - X M Ma
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - L J Shen
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - B Jin
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - H W Li
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China.
| | - J Han
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - G D Zhou
- Department of Pathology, 302 Military Hospital of China, Beijing, China
| | - S H Liu
- Department of Pathology, 302 Military Hospital of China, Beijing, China
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27
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Ikeda A, Nagayama S, Yamamoto N, Akiyoshi T, Konishi T, Fujimoto Y, Fukunaga Y, Ishikawa Y, Ueno M. A rare case of hepatocellular carcinoma metastasizing hematogenously to the rectum. Int Cancer Conf J 2016; 5:168-173. [PMID: 31149448 DOI: 10.1007/s13691-016-0251-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/14/2016] [Indexed: 11/25/2022] Open
Abstract
Metastasis to the gastrointestinal tract from hepatocellular carcinoma is uncommon. Herein, we report a rare case of with a metastatic lesion in the rectum, which resembled a primary rectal cancer. An 82-year-old Japanese woman, who had been diagnosed with liver cirrhosis and hepatocellular carcinoma due to chronic hepatitis C, was admitted for further examination of bloody stool. She had undergone radiofrequency ablation twice and transarterial chemoembolization twice before the admission. A colonoscopy revealed a protruding rectal tumor, which was confirmed by biopsy to be poorly differentiated adenocarcinoma. Meanwhile multiple liver recurrences were recognized by an abdominal computed tomography scan. To improve her symptoms and resume the treatment of hepatocellular carcinoma, laparoscopic anterior resection of the rectum was performed to remove the primary rectal cancer. To our surprise, detailed histological examination confirmed that the rectal tumor was a metastatic lesion from the hepatocellular carcinoma.
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Affiliation(s)
- Atsushi Ikeda
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Satoshi Nagayama
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Noriko Yamamoto
- 2Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Tsuyoshi Konishi
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Yoshiya Fujimoto
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Yosuke Fukunaga
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Yuichi Ishikawa
- 2Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
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28
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Coelho R, Orfão B, Santos-Antunes J, Rodrigues-Pinto E, Pereira P, Baldaia H, Macedo G. Upper Gastrointestinal Hemorrhage as an Unexpected Feature of Hepatocellular Carcinoma. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:172-174. [PMID: 28868400 PMCID: PMC5580097 DOI: 10.1016/j.jpge.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Rosa Coelho
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Branca Orfão
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | | | | | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Helena Baldaia
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
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29
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Metastatic Periampullary Tumor from Hepatocellular Carcinoma Presenting as Gastrointestinal Bleeding. Case Rep Gastrointest Med 2015; 2015:732140. [PMID: 26064707 PMCID: PMC4429209 DOI: 10.1155/2015/732140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/13/2015] [Indexed: 01/29/2023] Open
Abstract
Periampullary tumors constitute a number of diverse neoplastic lesions located within 2 cm of the major duodenal papilla; among these, metastatic lesions account for only a small proportion of the periampullary tumors. To our knowledge, a metastatic periampullary tumor from hepatocellular carcinoma has never been reported. A 62-year-old male reported to our institute for fatigue and low hemoglobin. His medical history was remarkable for multifocal hepatocellular carcinoma (HCC) treated with selective transcatheter arterial chemoembolization (TACE). An esophagogastroduodenoscopy (EGD) was performed which revealed a periampullary mass. Histopathology was consistent with metastatic moderately differentiated HCC. Two endoloops were deployed around the base of the mass one month apart. The mass eventually sloughed off and patient's hemoglobin level stabilized. We postulated that periampullary metastasis in this patient was the result of tumor fragments migration through the biliary tracts and that TACE which increases tumor fragments burden might have played a contributory role. Metastasis of HCC to the gastrointestinal (GI) tract should be considered as a cause of GI bleeding.
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Abstract
Hepatocellular carcinoma with colonic metastasis is rare. It mainly occurs by direct invasion and presents with bloody stools. We describe a patient with haematogenous metastasis to the rectum who presented with tenesmus. To our knowledge, such an association has not been reported previously. Colonic metastasis should be considered when patients with hepatocellular carcinoma present with bloody stools or tenesmus.
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31
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Abbas A, Medvedev S, Shores N, Bazzano L, Dehal A, Hutchings J, Balart L. Epidemiology of metastatic hepatocellular carcinoma, a nationwide perspective. Dig Dis Sci 2014; 59:2813-2820. [PMID: 24903653 DOI: 10.1007/s10620-014-3229-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/26/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver. AIMS The aim of this study was to describe the prevalence, trends, and predictors of metastatic HCC on a national scale. METHODS We used two nationwide datasets for our study: the University Health Consortium (UHC) and the Nationwide Inpatient Sample (NIS) databases. We included adults with a primary diagnosis of HCC from 2000 to 2011. We collected information regarding demographics, insurance, HCC risk factors, liver decompensation, and the sites and frequencies of metastases. Multivariable regression analysis was used to examine predictors of metastatic HCC. Trend analysis was performed to examine the change in metastatic HCC prevalence over time. RESULTS We included 25,671 and 26,054 HCC patients from UHC and NIS, respectively. Prevalence of metastatic HCC was 18 % with lung being the most frequent site (31 %). Compared with Caucasian, African American ethnicity was an independent predictor of metastasis in both the NIS [OR 1.13 (1.02-1.25)] and UHC [OR 1.4 (1.3-1.6)] databases. Lack of long-term insurance was associated with significantly higher prevalence of metastasis in both the NIS [OR 1.6 (1.4-1.9)] and UHC [OR 1.9 (1.6-2.2)] databases. There has been an increased prevalence of metastatic HCC over the last decade with an annual percentage change of +1.25 and +1.60 % (p = 0.03 and p = 0.08) for the NIS and UHC databases, respectively. CONCLUSIONS Metastasis is not rare among HCC patients and is rising in prevalence over the last decade. Lungs were the most common metastatic site. Ethnicity and insurance status are independent predictors of metastasis.
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Affiliation(s)
- Ali Abbas
- Department of Internal Medicine, Shands Hospital, University of Florida, 1600 SW Archer Road, PO BOX 100277, Gainesville, FL, 32610, USA,
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Oh SJ, Song HY, Nam DH, Ko HK, Park JH, Na HK, Lee JJ, Kang MK. Bleeding after expandable nitinol stent placement in patients with esophageal and upper gastrointestinal obstruction: incidence, management, and predictors. Acta Radiol 2014; 55:1069-75. [PMID: 24226292 DOI: 10.1177/0284185113511080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Placement of self-expandable nitinol stents is useful for the treatment of esophageal and upper gastrointestinal (GI) obstruction. However, complications such as stent migration, tumor overgrowth, and bleeding occur. Although stent migration and tumor overgrowth are well documented in previous studies, the occurrence of bleeding has not been fully evaluated. PURPOSE To evaluate the incidence, management strategies, and predictors of bleeding after placement of self-expandable nitinol stents in patients with esophageal and upper GI obstruction. MATERIAL AND METHODS We retrospectively reviewed the medical records and results of computed tomography and endoscopy of 1485 consecutive patients with esophageal and upper GI obstructions who underwent fluoroscopically guided stent placement. RESULTS Bleeding occurred in 25 of 1485 (1.7%) patients 0 to 348 days after stent placement. Early stent-related bleeding occurred in 10 patients (40%) and angiographic embolization was used for 5/10. Late bleeding occurred in 15 patients (60%) and endoscopic hemostasis was used for 7/15. Twenty-two of 25 (88%) patients with bleeding had received prior radiotherapy and/or chemotherapy. CONCLUSION Bleeding is a rare complication after placement of expandable nitinol stents in patients with esophageal and upper GI obstruction, but patients with early bleeding may require embolization for control. Care must be exercised on placing stents in patients who have received prior radiotherapy or chemotherapy.
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Affiliation(s)
- Se Jin Oh
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho-Young Song
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Deok Ho Nam
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Heung Kyu Ko
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Park
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han Kyu Na
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Jin Lee
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Kyoung Kang
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Grover I, Ahmad N, Googe AB. Hepatogastric Fistula following Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma. Case Rep Gastroenterol 2014; 8:286-90. [PMID: 25408632 PMCID: PMC4224249 DOI: 10.1159/000368302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Hepatogastric fistula (HGF) formation following transcatheter arterial chemoembolization (TACE) leads to increased morbidity and mortality. A 51-year-old Caucasian male with chronic hepatitis B virus-associated cirrhosis and unresectable hepatocellular carcinoma (HCC) presented to the Interventional Radiology Unit for TACE to achieve tumor necrosis. Following the procedure, the patient was admitted with symptoms of fever, epigastric and right upper quadrant pain secondary to the development of an abscess. The abscess was drained; however, an exceedingly rare HGF resulted that was favored to represent a direct invasion of HCC. HGF, the rare complication following TACE, leads to grave consequences and vigilant monitoring, for the development of this entity is recommended to reduce patient mortality. We present a case and literature review of HGF development following TACE for HCC.
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Affiliation(s)
- Inderpreet Grover
- Internal Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Miss., USA
| | - Naveed Ahmad
- Department of Gastroenterology, Indiana University Health Arnett, Lafayette, Ind., USA
| | - Amber B Googe
- University of Mississippi Medical Center, Jackson, Miss., USA
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Kohli R, Purysko AS, John BV. Hematochezia from metastasis of hepatocellular carcinoma to colon in a patient who underwent liver transplantation. Clin Gastroenterol Hepatol 2014; 12:A23-4. [PMID: 24657841 DOI: 10.1016/j.cgh.2014.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/21/2014] [Accepted: 03/10/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Ruhail Kohli
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Binu V John
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
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35
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Igawa A, Oka S, Tanaka S, Nakano M, Aoyama T, Watari I, Aikata H, Arihiro K, Chayama K. Small bowel metastasis of hepatocellular carcinoma detected by capsule endoscopy. Case Rep Gastroenterol 2013; 7:492-7. [PMID: 24474898 PMCID: PMC3901617 DOI: 10.1159/000357302] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We report a rare case of metastasis of hepatocellular carcinoma (HCC) to the small bowel that presented as a pedunculated epithelial polyp. A 60-year-old man with liver cirrhosis type B was treated for HCC (stage IVb) at our hospital. He had been admitted for melena and anemia. Capsule endoscopy was performed in this patient with obscure gastrointestinal bleeding. It showed a polypoid lesion with bleeding in the ileum. Double-balloon endoscopy was performed. The lesion was determined to be a pedunculated polyp in the ileum. Histological examination of biopsy specimens showed tumor cells resembling HCC. We performed endoscopic mucosal resection for the lesion by double-balloon endoscopy to prevent bleeding from the tumor. The patient had no melena or anemia and his condition improved after endoscopic mucosal resection. However, he died of liver failure 2 months later.
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Affiliation(s)
- A Igawa
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - S Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - S Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - M Nakano
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - T Aoyama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - I Watari
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - H Aikata
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - K Arihiro
- Department of Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - K Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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36
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Sayana H, Yousef O, Clarkston WK. Massive upper gastrointestinal hemorrhage due to invasive hepatocellular carcinoma and hepato-gastric fistula. World J Gastroenterol 2013; 19:7472-7475. [PMID: 24259980 PMCID: PMC3831231 DOI: 10.3748/wjg.v19.i42.7472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
A 36-year-old male Asian immigrant with a history of hepatitis B and hepatitis C related unresectable hepatocellular carcinoma in the left lobe of the liver presented with hematemesis and severe anemia. He was diagnosed with a liver mass that was resected 8 years ago described as a benign tumor in his home country. He had received trans-arterial chemoembolization (TACE) four months ago after subsequent diagnosis of unresectable hepatoma, and currently was receiving chemotherapy with Sorafenib. After resuscitation, a contrast enhanced computerized tomography was performed which showed fistulization of hepatocellular carcinoma into adjacent stomach. This finding was confirmed during endoscopy with direct visualization of the fistulous opening. Hepatocellular carcinoma (HCC) invading the gastrointestinal (GI) tract is rare. We present a case and literature review of HCC with local invasion of the stomach causing massive upper GI bleeding after receiving TACE.
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37
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Hu JB, Zhu YH, Jin M, Sun XN. Gastric and duodenal squamous cell carcinoma: metastatic or primary? World J Surg Oncol 2013; 11:204. [PMID: 23957943 PMCID: PMC3751751 DOI: 10.1186/1477-7819-11-204] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 08/07/2013] [Indexed: 11/23/2022] Open
Abstract
Either metastatic or primary squamous cell carcinoma in the gastrointestinal tract is extremely rare, with very few cases reported in the literature. In this paper, we report a case in which the patient presented with dysphagia during the course of radiotherapy for recurrent lung cancer in a mediastinal lymph node. Although the dysphagia mimicked radiation esophagitis, the ultimate cause proved to be gastric and duodenal metastases from primary lung squamous cell carcinoma. Taking into account the value of identification of metastatic or primary SCC in the stomach and duodenum on the prognosis and treatment options, it is imperative that the correct diagnosis be established. This report is followed by a discussion of the differential diagnosis between metastatic and primary squamous cell carcinoma in the stomach and duodenum.
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Affiliation(s)
- Jian-Bin Hu
- Department of Radiation Oncology, Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province 310016, China
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38
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Lee YJ, Kim JH, Song HY, Park JH, Na HK, Kim PH, Fan Y. Hepatocellular carcinoma complicated by gastroduodenal obstruction: palliative treatment with metallic stent placement. Cardiovasc Intervent Radiol 2012; 35:1129-1135. [PMID: 21882080 DOI: 10.1007/s00270-011-0262-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 08/14/2011] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the clinical effectiveness of self-expandable metallic stents in seven patients with malignant gastroduodenal obstruction caused by inoperable hepatocellular carcinoma (HCC). METHODS Seven patients with gastroduodenal obstruction caused by advanced HCC underwent metallic stent placement from 2003 to 2010. These patients had total dysphagia (n = 5) or were able to eat only liquids (n = 2) before stent placement. Patients had Eastern Cooperative Oncology Group performance scores of 2 or 3, and Child-Pugh classification B or C. RESULTS Stent placement was technically successful in all seven patients (100%) and clinically successful in six (86%). Five patients could eat a soft diet, and one patient tolerated regular diet after stent placement. Stent-related obstructive jaundice occurred in one patient. One patient had hematemesis 11 days after stent placement. Overall mean survival was 51 days (range, 10-119 days). Stent patency was preserved in six patients with clinical success until death. CONCLUSION Placement of a covered self-expandable metallic stent may offer good palliation in patients with gastroduodenal obstruction due to advanced HCC.
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Affiliation(s)
- Ye Jin Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
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39
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Imada S, Noura S, Ohue M, Shingai T, Sueda T, Gotoh K, Yamada T, Tomita Y, Yano M, Ishikawa O. Recurrence of hepatocellular carcinoma presenting as an asymptomatic appendiceal tumor: report of a case. Surg Today 2012; 43:685-9. [PMID: 22797964 DOI: 10.1007/s00595-012-0257-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 02/13/2012] [Indexed: 11/28/2022]
Abstract
This report presents the case of a 66-year-old male with appendicular metastasis from hepatocellular carcinoma. He had a clinical history of right lobectomy of the liver after the diagnosis of hepatocellular carcinoma 3 years prior, and was admitted because of an asymptomatic appendiceal tumor detected by computed tomography. The appendiceal tumor was preoperatively suspected to be a recurrence of hepatocellular carcinoma, because of the patient's elevated level of serum α-fetoprotein and protein induced by vitamin K absence or antagonist II, and based on the magnetic resonance imaging findings. An appendectomy was thus performed, and the histopathological findings confirmed the diagnosis of a metastatic tumor from hepatocellular carcinoma. Appendicular metastasis is extremely rare. This is only the second case of a metastatic appendiceal tumor from hepatocellular carcinoma reported in the English literature.
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Affiliation(s)
- Shinya Imada
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan
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40
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Sauer BG, Dustin SM, Caldwell SH. Liver invasion of the duodenum due to hepatocellular carcinoma. Clin Gastroenterol Hepatol 2012; 10:A25. [PMID: 22230165 DOI: 10.1016/j.cgh.2011.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 12/22/2011] [Accepted: 12/28/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Bryan G Sauer
- Division of Gastroenterology, University of Virginia, Charlottesville, Virginia, USA
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41
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Liang JD, Chen CH, Hsu SJ, Sheu JC, Yang PM, Lee HS, Lee CZ, Huang GT. Hepatocellular carcinoma with duodenal invasion and metastasis. J Gastroenterol Hepatol 2012; 27:677-83. [PMID: 21793909 DOI: 10.1111/j.1440-1746.2011.06869.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM Hepatocellular carcinoma (HCC) is the leading cause of cancer-related deaths in Taiwan. HCC with duodenal involvement are rare and are associated with a poor prognosis. The purpose of this retrospective study was to collect clinical information and data regarding survival following various treatments. METHODS Between 1996 and 2009, 21 cases (17 men) were diagnosed with HCC and duodenal invasion and metastases by diagnostic imaging, endoscopy with biopsy, or surgically collected specimens sent to pathology. The clinical course was analyzed from the patients' medical records. RESULTS Gastrointestinal bleeding was reported in 18/21 patients. Diagnostic imaging showed that the majority of cases involved direct tumor invasion (predominantly from the right liver lobe) and six cases from metastasis. Tumor mass and ulcerations were the most common features noted on endoscopy. In addition to the component therapy and medication treatment, panendoscopic hemostasis, surgery, transcatheter arterial embolization, and radiotherapy were performed for the management of duodenal involvement and gastrointestinal bleeding. Survival duration after duodenal involvement ranged from 0.2 to 57.8 months (mean 10.5 months). CONCLUSIONS Gastrointestinal bleeding in advanced HCC should raise suspicions of duodenal involvement. HCC can involve the duodenum by direct invasion (from either the left or right liver lobes) or metastasis. The prognosis for HCC patients with duodenal involvement is poor, but is improved by supportive care and application of various treatment modalities.
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Affiliation(s)
- Ja-Der Liang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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42
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Kim JN, Lee HS, Kim SY, Kim JH, Jung SW, Koo JS, Yim HJ, Lee SW, Choi JH, Kim CD, Ryu HS. Endoscopic treatment of duodenal bleeding caused by direct hepatocellular carcinoma invasion with an ethanol injection. Gut Liver 2012; 6:122-5. [PMID: 22375182 PMCID: PMC3286730 DOI: 10.5009/gnl.2012.6.1.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/10/2010] [Indexed: 11/04/2022] Open
Abstract
We report a case of a man who developed duodenal bleeding caused by direct hepatocellular carcinoma (HCC) invasion, which was successfully treated with endoscopic ethanol injection. A 57-year-old man with known HCC was admitted for melena and exertional dyspnea. He had been diagnosed with inoperable HCC a year ago. Urgent esophagogastroduodenoscopy (EGD) showed two widely eroded mucosal lesions with irregularly shaped luminal protruding hard mass on the duodenal bulb. Argon plasma coagulation and Epinephrine injection failed to control bleeding. We injected ethanol via endoscopy to control bleeding two times with 14 cc and 15 cc separately without complication. Follow-up EGD catched a large ulcer with necrotic and sclerotic base but no bleeding evidence was present. He was discharged and he did relatively well during the following periods. In conclusion, Endoscopic ethanol injection can be used as a significantly effective and safe therapeutic tool in gastrointestinal tract bleeding caused by HCC invasion.
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Affiliation(s)
- Jin Nam Kim
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Jeong GH, Ye BD, Myung SJ. [Multiple colonic metastases from hepatocellular carcinoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 58:288-92. [PMID: 22113048 DOI: 10.4166/kjg.2011.58.5.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Gwi Hong Jeong
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lin TL, Yap AQ, Wang JH, Chen CL, Iyer SG, Low JK, Lin CC, Li WF, Chen TY, Bora D, Lin CY, Wang CC. Long term survival in patients with hepatocellular carcinoma directly invading the gastrointestinal tract: case reports and literature review. Surg Oncol 2011; 20:e207-14. [PMID: 21824763 DOI: 10.1016/j.suronc.2011.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/09/2011] [Accepted: 06/29/2011] [Indexed: 01/28/2023]
Abstract
Hepatocellular carcinoma (HCC) directly invading the gastrointestinal (GI) organs is rare and is associated with poor survival outcome. We report two patients with good long-term outcome following resection of HCC that invaded the stomach and duodenum, respectively. A literature review was conducted to elucidate the course of patients with this pathology. Two cases (57-year-old and 72-year-old males) with enlarged hepatic tumors directly invading the stomach and duodenum underwent hepatectomies with en-bloc resection of the involved organs. Both patients are still alive at 80 and 68 months following the surgery. Our literature review showed that most of the patients with this pathology have manifested, and died of persistent GI bleeding. Patients who were treated surgically had a statistically significant longer survival than those who were treated with non-surgical palliative treatments (P < 0.001). In addition, patients who were treated with surgery with curative intent tend to have a longer survival times than those who were treated with surgery to palliate the bleeding but the difference was not statistically significant (P < 0.174). Removing the tumor completely could significantly prolong the survival of patients with HCC invading the GI tract.
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Affiliation(s)
- Ting-Lung Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
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Yoo DJ, Chung YH, Lee YS, Kim SE, Jin YJ, Lee YM, Kim MJ. Sigmoid colon metastasis from hepatocellular carcinoma. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 16:397-400. [PMID: 21415584 PMCID: PMC3304608 DOI: 10.3350/kjhep.2010.16.4.397] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hepatocellular carcinoma (HCC) is a major health problem worldwide, and it has a poor prognosis. Extrahepatic metastasis from HCC is not unusual, with direct invasion representing the main spreading mode. Sites that are frequently involved are the lung, bone, and lymph nodes. There are few reports of HCC invading the distant gastrointestinal tract, especially hematogenously. Herein we report a case of sigmoid colon metastasis from HCC. The patient was diagnosed with HCC and treated with transcatheter arterial chemoembolization (TACE). Eighteen months after TACE the patient presented with abdominal pain on the left lower quadrant, and a CT scan showed an enhanced mass on the sigmoid colon. Immunohistochemical staining revealed that a tumor cell was positive for polyclonal carcinoembryonic antigen and weakly positive for hepatocyte antigen, supporting the diagnosis of HCC metastasis. The patient underwent anterior resection for the metastatic HCC.
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Affiliation(s)
- Dong Jun Yoo
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Park H, Kim SU, Choi J, Park JY, Ahn SH, Han KH, Chon CY, Park YN, Kim DY. Hepatogastric fistula caused by direct invasion of hepatocellular carcinoma after transarterial chemoembolization and radiotherapy. THE KOREAN JOURNAL OF HEPATOLOGY 2010; 16:401-404. [PMID: 21415585 PMCID: PMC3304605 DOI: 10.3350/kjhep.2010.16.4.401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 08/17/2010] [Accepted: 09/02/2010] [Indexed: 12/24/2022]
Abstract
A 63-year-old man with a history of hepatitis-B-related hepatocellular carcinoma (HCC) in the left lateral portion of the liver received repeated transcatheter arterial chemoembolization (TACE) and salvage radiotherapy. Two months after completing radiotherapy, he presented with dysphagia, epigastric pain, and a protruding abdominal mass. Computed tomography showed that the bulging mass was directly invading the adjacent stomach. Endoscopy revealed a fistula from the HCC invading the stomach. Although the size of the mass had decreased with the drainage through the fistula, and his symptoms had gradually improved, he died of cancer-related bleeding and hepatic failure. This represents a case in which an HCC invaded the stomach and caused a hepatogastric fistula after repeated TACE and salvage radiotherapy.
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Affiliation(s)
- Hana Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Junjeong Choi
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Chae Yoon Chon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Korea
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Kato Y, Matsubara K, Akiyama Y, Hattori H, Hirata A, Yamamoto T, Suzuki F, Ohtaka H, Sugiura Y, Kitajima M. Direct biliopancreatoduodenal invasion by hepatocellular carcinoma: report of the first resected case and review of the literature. Int J Clin Oncol 2010; 16:421-7. [DOI: 10.1007/s10147-010-0136-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 09/09/2010] [Indexed: 12/21/2022]
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Kahn J, Kniepeiss D, Langner C, Wagner D, Iberer F, Tscheliessnigg K. Oesophageal metastases of hepatocellular carcinoma after liver transplantation. Transpl Int 2010; 23:438-9. [PMID: 19761554 DOI: 10.1111/j.1432-2277.2009.00967.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Hu ML, Tai WC, Chuah SK, Chiu YC, Wu KL, Chou YP, Kuo CM, Hu TH, Chiu KW. Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway. J Gastroenterol Hepatol 2010; 25:408-412. [PMID: 19929932 DOI: 10.1111/j.1440-1746.2009.06022.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM Hepatocellular carcinoma (HCC) tends to metastasize to extrahepatic organs. Stomach involvement has been seldom reported and has always been considered as direct invasion. This study aims to propose a possible existing pathway for the hematogenous metastasis of HCC to the stomach. METHODS Only seven cases with stomach involvement were found from 8267 HCC patients registered at our hospital between 2000 and 2007. Their laboratory data, the findings of computed tomography and upper endoscopy, therapeutic procedures, such as esophageal variceal banding ligation (EVL), and transhepatic arterial embolization (TAE) were further studied. RESULTS All seven patients were male. Liver cirrhosis was found in six patients (6/7 = 85.7%), HCC with portal vein thrombosis (PVT) in six patients (6/7 = 85.7%), splenomegaly in five patients (5/7 = 71.4%) and esophageal varices in five patients (5/7 = 71.4%). Six patients underwent TAE and one patient underwent EVL before the development of HCC in the stomach. Four patients had HCC at the cardia, one patient at the anterior wall of the high body and two patients at the greater curvature of the high body, far away from the original HCC. Six patients eventually developed distant metastasis. HCC with gastric metastasis developed 53-126 days after TAE in five patients and 74 days after EVL in one patient. CONCLUSIONS When cirrhotic patients with portal hypertension have HCC with PVT, a hematogenous pathway can exist for gastric metastasis of tumor thrombi involving hepatofugal flow to the stomach after TAE or EVL apart from the major pathway of direct invasion.
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Affiliation(s)
- Ming-Luen Hu
- Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
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Chung C, Al Ali J, Owen DA, Weiss AA, Yoshida EM, Tai IT. A rare case of isolated duodenal metastases from hepatocellular carcinoma associated with p53 and ki-67 expression: a case report. CASES JOURNAL 2009; 2:9344. [PMID: 20062599 PMCID: PMC2803999 DOI: 10.1186/1757-1626-2-9344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/17/2009] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver worldwide. The incidence of HCC is increasing in North America secondary to rises in chronic liver disease from alcohol abuse and viral hepatitis. HCC most commonly metastasizes hematogenously or through lymphatics to the lungs and regional lymph nodes. Involvement of small bowel is rare and typically results from direct invasion and extension. We examined the molecular features related to this extremely rare case of isolated duodenal metastasis of HCC and noted p53 and Ki-67 positive staining. Here, we review the possible molecular and immunohistochemical studies that may aid definitive diagnosis and the evidence for the management of metastatic hepatocellular carcinoma.
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Affiliation(s)
- Caroline Chung
- Radiation Oncology, BC Cancer Agency, 600 W10th Ave, Vancouver, V5Z 4E6, Canada
| | - Jaber Al Ali
- Division of Gastroeneterology, Vancouver General Hospital, 899 12th Ave, Vancouver, V5Z 1M9, Canada
| | - David A Owen
- Department of Pathology, Vancouver General Hospital, 899 12th Ave, Vancouver, V5Z 1M9, Canada
| | - Alan A Weiss
- Division of Gastroeneterology, Vancouver General Hospital, 899 12th Ave, Vancouver, V5Z 1M9, Canada
| | - Eric M Yoshida
- Division of Gastroeneterology, Vancouver General Hospital, 899 12th Ave, Vancouver, V5Z 1M9, Canada
| | - Isabella T Tai
- Division of Gastroeneterology, Vancouver General Hospital, 899 12th Ave, Vancouver, V5Z 1M9, Canada
- Genome Sciences Centre, 675 W10th Ave, Vancouver, V5Z 1L3, Canada
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