Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2020; 26(42): 6698-6705
Published online Nov 14, 2020. doi: 10.3748/wjg.v26.i42.6698
Intussusception due to hematogenous metastasis of hepatocellular carcinoma to the small intestine: A case report
Taro Mashiko, Yoshihito Masuoka, Akira Nakano, Kota Tsuruya, Shunji Hirose, Kenichi Hirabayashi, Tatehiro Kagawa, Toshio Nakagohri
Taro Mashiko, Yoshihito Masuoka, Akira Nakano, Toshio Nakagohri, Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
Kota Tsuruya, Shunji Hirose, Tatehiro Kagawa, 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
Author contributions:  Nakagohri T, Masuoka Y, Nakano A and Mashiko T were the patient’s surgeons, reviewed the literature, and drafted the manuscript; Kagawa T, Hirose S and Tsuruya K helped in the treatment of hepatocellular carcinoma and provided clinical data; Hirabayashi K performed the pathological analysis; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Taro Mashiko, MD, Doctor, Surgeon, Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 2591193, Kanagawa, Japan. mt334592@tsc.u-tokai.ac.jp
Received: August 29, 2020
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
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.

Keywords: Hepatocellular carcinoma, Hematogenous metastases, Extrahepatic metastasis, Small intestinal metastasis, Intussusception, Case report

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.