Published online Nov 14, 2020. doi: 10.3748/wjg.v26.i42.6698
Peer-review started: August 29, 2020
First decision: September 12, 2020
Revised: September 23, 2020
Accepted: October 13, 2020
Article in press: October 13, 2020
Published online: November 14, 2020
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.
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.
Prognosis of HCC patients with GI tract metastasis is usually poor, but in some cases, multidisciplinary therapy may prolong survival.
Core Tip: Intussusception due to hematogenous metastasis of hepatocellular carcinoma (HCC) to the gastrointestinal (GI) tract is an extremely rare condition in patients with HCC. Patients with GI tract metastasis of HCC usually have a poor prognosis because of the advanced tumor stage. Surgical treatment of extrahepatic metastasis of HCC has still not been established. However, this case report suggests that selected patients with extrahepatic metastasis of HCC may achieve prolonged survival with multidisciplinary therapy including surgical resection.