Published online Aug 6, 2019. doi: 10.12998/wjcc.v7.i15.2044
Peer-review started: April 19, 2019
First decision: June 21, 2019
Revised: June 29, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 6, 2019
Hepatocellular carcinoma (HCC) accounts for 5-6% of all human cancers. Considering the extrahepatic metastasis, the main organs involved are lymphnodes, lung, bone and adrenal gland. Usually colon metastasis is very rare, especially on the left sided colon.
We report a case of a 70 years-old man hepatitis B carrier with HCC treated four times with trans-arterial chemoembolization, presented to our surgical department complaining of gastrointestinal bleeding. A colonoscopy revealed a mass of 4 cm of the sigmoid colon with signs of bleeding. The computed tomography showed a mass originated from the sigmoid colon of 3.5 cm, and the presence of HCC in segment VI and VII, without portal vein thrombosis. Due to the large size of the mass and the active bleeding, the patient underwent a left colectomy. The postoperative period was uneventful, and the patient was discharged in fifth post-operative day. Histological examination revealed that the neoplasm was characterized by a diffuse proliferation of epithelial cells with an hepatoid differentiation. So, the presence of a history of HCC of the liver and the histopathological features supported the diagnosis of metastasis from the liver.
Although rare, colon metastasis from an HCC can be left-sided and can present with acute bleeding.
Core tip: Colon metastasis from hepatocellular carcinoma are extremely rare and, when present, they usually located in the right colon. We present a case of a left sided colon metastasis, which presented with acute bleeding and anemia for which the patient underwent left hemicolectomy.