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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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Endo Y, Shimazu M, Sakuragawa T, Uchi Y, Edanami M, Sunamura K, Ozawa S, Chiba N, Kawachi S. Successful treatment with laparoscopic surgery and sequential multikinase inhibitor therapy for hepatocellular carcinoma: A case report. World J Gastrointest Surg 2022; 14:260-267. [PMID: 35432767 PMCID: PMC8984515 DOI: 10.4240/wjgs.v14.i3.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with massive portal vein tumor thrombosis (PVTT) and distant metastasis is considered unresectable. However, due to recent developments in systemic chemotherapy, successful cases of conversion therapy for unresectable diseases have been reported. Herein, we report a successful multidisciplinary approach for treatment of multi-visceral recurrence with sequential multikinase inhibitor and laparoscopic surgery.
CASE SUMMARY A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with HCC. Subsequently, she underwent two rounds of laparoscopic partial hepatectomy, laparoscopic left adrenalectomy, and transcatheter arterial chemoembolization plus sorafenib for recurrence. Four years after initial hepatectomy, she presented with a 43-mm mass in the spleen and tumor thrombus involving the main portal vein trunk with ascites. Her liver function was Child-Pugh B (8), and protein induced by vitamin K absence or antagonist II (PIVKA II) levels were elevated up to 46.291 mAU/mL. Since initial treatment with regorafenib for three months was unsuccessful, the patient was administered lenvatinib. Ten months post-treatment, there was no contrast enhancement of PVTT or splenic metastasis. Chemotherapy was discontinued due to severe diarrhea. Afterward, splenic metastasis became viable, and PIVKA II increased. Therefore, hand-assisted laparoscopic splenectomy was performed. She experienced no clinical recurrence 14 mo after resection.
CONCLUSION Conversion surgery after successful multikinase inhibitor treatment might be considered an effective treatment option for advanced HCC.
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Affiliation(s)
- Yutaka Endo
- Department of Surgery, Tama Kyuryo Hospital, Tokyo 1940297, Japan
| | - Motohide Shimazu
- Department of Surgery, Tama Kyuryo Hospital, Tokyo 1940297, Japan
| | | | - Yusuke Uchi
- Department of Surgery, Tama Kyuryo Hospital, Tokyo 1940297, Japan
| | - Motonori Edanami
- Department of Surgery, Tama Kyuryo Hospital, Tokyo 1940297, Japan
| | - Ken Sunamura
- Department of Surgery, Tama Kyuryo Hospital, Tokyo 1940297, Japan
| | - Soji Ozawa
- Department of Surgery, Tama Kyuryo Hospital, Tokyo 1940297, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo 1930998, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo 1930998, Japan
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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: 0.8] [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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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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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: 0.4] [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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Qian L, Huang J, Qin H. Glypican-3-expressing gastric metastasis of hepatocellular carcinoma via curative subtotal gastrectomy: a case report. J Gastrointest Cancer 2014; 45 Suppl 1:166-9. [PMID: 24777446 DOI: 10.1007/s12029-014-9613-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Leimin Qian
- Clinical Medicine College of Shanghai Tenth People's Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210029, China,
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Small intestinal metastasis from intrahepatic cholangiocarcinoma: report of a case. Surg Today 2011; 41:859-64. [PMID: 21626338 DOI: 10.1007/s00595-010-4358-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 04/28/2010] [Indexed: 02/07/2023]
Abstract
Metastasis of the small intestine that derives from a primary hepatic neoplasm is rare. We encountered a case of intrahepatic cholangiocarcinoma (ICC) with jejunal metastasis after resection of a primary lesion. A 61-year-old male patient was referred to us with a diagnosis of liver tumors. Partial hepatectomy was performed, and the pathological diagnosis was ICC. Seventeen months after surgery, the patient was found to have a mass in the jejunum and lymph node swelling by positron emission tomography-computed tomography. The jejunal tumor was preoperatively diagnosed as a metastasis of ICC from a biopsy specimen obtained by double balloon endoscopy, and the tumor was resected. The patient received systemic chemotherapy but succumbed with ICC recurrence 46 months after the primary surgery. To the best of our knowledge, this case is the first report of jejunal recurrence of ICC. In addition, this report suggests the usefulness of double balloon endoscopy to make the correct diagnosis of the jejunal tumor.
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Gatenby PAC, Mudan SS, Wotherspoon AC. Splenectomy for non-haematological metastatic malignant disease. Langenbecks Arch Surg 2011; 396:625-38. [DOI: 10.1007/s00423-011-0746-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 01/26/2011] [Indexed: 12/25/2022]
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Yan ML, Wang YD, Lai ZD, Tian YF, Chen HB, Qiu FN, Zhou SQ. Pedunculated hepatocellular carcinoma and splenic metastasis. World J Gastroenterol 2009; 15:5239-41. [PMID: 19891029 PMCID: PMC2773909 DOI: 10.3748/wjg.15.5239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Only a few cases of pedunculated hepatocellular carcinoma (P-HCC) have been reported in the literature. The common sites of extrahepatic metastases in patients with HCC are the lungs, regional lymph nodes, kidney, bone marrow and adrenals. Metastasis to spleen is mostly via hematogenous metastasis, direct metastasis to spleen was very rare. We report a case of P-HCC presenting as a left upper abdominal lesions which involved the spleen that was actually a P-HCC with splenic metastasis. This case is unique as P-HCC directly involved the spleen which is not via hematogenous metastasis.
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