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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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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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Liu YH, Lo EYJ, Lee KF, Chong CCN, Lai PBS. An unusual cause of upper gastrointestinal bleeding due to recurrent hepatocellular carcinoma: A case report. Int J Surg Case Rep 2020; 70:83-86. [PMID: 32416488 PMCID: PMC7226638 DOI: 10.1016/j.ijscr.2020.04.008] [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: 01/27/2020] [Revised: 03/20/2020] [Accepted: 04/02/2020] [Indexed: 01/02/2023] Open
Abstract
Hepatocellular carcinoma invading to gastrointestinal tract can present as bleeding. Invasion to gastrointestinal tract by hepatocellular carcinoma is relatively rare. Long term survival can be achieved by en bloc resection even if hepatocellular carcinoma invades into nearby organs.
Introduction Upper gastrointestinal bleeding (UGIB) in patients suffering from hepatocellular carcinoma (HCC) is usually due to oesophageal or gastric varices secondary to portal hypertension. Very rarely, HCC can directly invade into the stomach or duodenum resulting in UGIB. Presentation of case A 62-year-old man presented to the emergency department for haematemesis and tarry stool. He was a hepatitis B carrier and had received open radiofrequency ablation and wedge resection for HCC previously. Urgent endoscopy and contrast computed tomography confirmed recurrent HCC invading into the duodenum. The patient received radical resection and remained disease free for 7 years after the operation. Discussion Direct invasion into gastrointestinal tract by HCC is rare. Different modalities of treatment have been reported in the literature with variable success. En-bloc resection should be considered if surgically feasible in order to achieve good haemostasis and possible long term survival. Conclusion Upper gastrointestinal bleeding is a rare presentation of hepatocellular carcinoma and long term survival can be achieved by curative surgery.
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Affiliation(s)
- Yuk Ho Liu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Hong Kong.
| | - Eugene Yee Juen Lo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - Kit Fai Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Hong Kong
| | | | - Paul Bo San Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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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: 0.2] [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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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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Tan WJ, Chia CS, Ong HS. A rare cause of gastrointestinal haemorrhage: gastric invasion by hepatocellular carcinoma. J Surg Case Rep 2013; 2013:rjs050. [PMID: 24963938 PMCID: PMC3579534 DOI: 10.1093/jscr/rjs050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients with hepatocellular carcinoma (HCC) are predisposed to upper gastrointestinal (GI) haemorrhage with bleeding gastro-oesophageal varices and peptic ulcers being the common aetiologies. On rare occasions, HCC with direct invasion into the upper GI tract can lead to haemorrhage. Recognizing the possibility of invasive HCC causing upper GI haemorrhage is of paramount importance as acute management differs from the usual aetiologies. We describe a 76-year-old lady with long-standing liver cirrhosis who presented with upper GI haemorrhage due to an HCC invading into the greater curvature of the stomach. Trans-arterial embolization was performed which led to successful cessation of bleeding. Direct invasion of the GI tract by HCC causing haemorrhage is an extremely rare condition. Compared with endoscopic therapy, trans-arterial embolization offers the best chance of successful haemostasis and should be considered first-line therapy in these patients.
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Affiliation(s)
| | | | - Hock Soo Ong
- Department of General Surgery, Singapore General Hospital, Singapore
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