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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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Miyauchi W, Yamamoto M, Masahiro M, Shishido Y, Miyatani K, Matsunaga T, Sakamoto T, Fujiwara Y. Colonic metastasis of hepatocellular carcinoma with repeated retroperitoneal bleeding: a case report. Surg Case Rep 2021; 7:261. [PMID: 34921642 PMCID: PMC8684546 DOI: 10.1186/s40792-021-01349-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colonic metastasis is uncommon in patients with hepatocellular carcinoma (HCC). In the past, extrahepatic metastasis of HCC was not treated aggressively because of its poor prognosis. Herein, we describe the case of a patient with HCC who survived for 30 months following resection of a metastatic tumor in the ascending colon. CASE PRESENTATION An 80-year-old man presented at our hospital with symptoms of abdominal pain on the right side and fever. He had undergone transcatheter arterial chemoembolization and posterior segment resection of the liver because of HCC, followed by radiofrequency ablation for a recurrent intrahepatic lesion 5 and 3 years, respectively, prior to the visit. He was diagnosed with retroperitoneal hematoma, which was thought to be associated with diverticulitis and an extramural tumor in the ascending colon. A definitive diagnosis could not be reached; however, a right hemicolectomy of the colon was performed because of progression to anemia. A pathological examination revealed a metastatic tumor in the ascending colon extending from the subserosal layer to the muscularis propria layer. The patient was treated with lenvatinib after surgery, but presented with intrahepatic recurrence, lymph node metastasis, and peritoneal dissemination metastasis 15 months later. The progression of the disease could not be controlled and his postoperative survival time was 30 months. CONCLUSION Resection of metastasis of HCC might contribute to prolonged survival in cases, where radical resection is possible.
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Affiliation(s)
- Wataru Miyauchi
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Makinoya Masahiro
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8504 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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Shiozaki T, Hayakawa K, Tanikake M, Oida T, Hida S, Yasui H, Urata Y, Tanaka A, Morimoto T. Accumulation of 99mTc-PMT in renal metastasis of hepatocellular carcinoma. Ann Nucl Med 2003; 17:333-6. [PMID: 12932119 DOI: 10.1007/bf02988531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe here a case in which 99mTc-Sn-N-pyridoxy-5-methyltryptophan (99mTc-PMT) scintigraphy was useful in diagnosing renal metastasis of hepatocellular carcinoma (HCC). A 62-year-old man who had undergone hepatectomy for HCC presented 6 years after initial diagnosis with left flank pain and was found on CT and MRI to have a tumor in the left kidney. Hepatobiliary scintigraphy using 99Tc-PMT was performed, and 99mTc-PMT accumulation was found in the tumor. Nephrectomy was performed and metastasis of HCC was confirmed.
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Mochizuki T, Tsuda T, Sugawara Y, Tanaka H, Kikuchi T, Miyagawa M, Shimizu K, Murase K, Iuchi H, Onji M, Ikezoe J. Tc-99m PMT hepatobiliary scintigraphy in the differential diagnosis of extrahepatic metastases and hepatocellular carcinoma. Clin Nucl Med 2000; 25:991-5. [PMID: 11129165 DOI: 10.1097/00003072-200012000-00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The authors evaluated the utility of hepatobiliary scintigraphy for tissue characterization of extrahepatic metastases from hepatocellular carcinoma (HCC) using Tc-99m N-pyrydoxyl-5-methyltriptophane (Tc-99m PMT). METHODS We examined 13 patients with HCC (29 extrahepatic metastases and 3 benign bone lesions) and 5 patients with other cancers (15 extrahepatic metastases). Thirty minutes to 6 hours after intravenous administration of Tc-99m PMT, planar (all 47 lesions) and SPECT (42 lesions) images were obtained. Accumulation of Tc-99m PMT in the lesion was evaluated visually by comparing bone scintigraphy, computed tomography, magnetic resonance imaging, or all of these. RESULTS Findings were positive in 12 of 13 patients with HCC and extrahepatic metastases (16 of 29 on planar imaging and 21 of 26 on SPECT). Findings in all three benign bone lesions and 15 metastatic lesions from non-HCC primary lesions were negative (0 of 18 on planar imaging, 0 of 16 on SPECT). There were no false-positive findings in these lesions. Lesion-by-lesion sensitivity, specificity, accuracy, and positive and negative predictive values were 55%, 100%, 72%, 100%, and 58% by planar imaging and 81%, 100%, 88%, 100%, and 76% by SPECT, respectively. CONCLUSIONS Because of the high specificity and reasonable sensitivity, Tc-99m PMT appears to be useful for the differential diagnosis of extrahepatic metastases from HCC. SPECT improves the detectability of small or faint accumulation in metastases from HCC.
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Affiliation(s)
- T Mochizuki
- Department of Radiology, Ehime University School of Medicine, Onsen-gun, Japan.
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Hayase N, Fukumoto M, Yoshida D, Kariya S, Akagi N, Kurohara A, Hisa N, Yoshida S. Extraosseous metastases of hepatocellular carcinoma detection and therapeutic assessment with Tc-99m PMT SPECT. Clin Nucl Med 1999; 24:326-9. [PMID: 10232470 DOI: 10.1097/00003072-199905000-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Owing to recent advances in imaging technology and radiologic intervention, survival rates in patients with hepatocellular carcinoma have improved markedly. However, such prolonged survival has resulted in an increase in extrahepatic metastases. Tc-99m (Sn)-N-pyridoxyl-5-methyltryptophan (Tc-99m PMT), developed for hepatobiliary scintigraphy, has been used to visualize extrahepatic metastases, with most related reports limited to osseous metastases. The authors report two cases of hepatocellular cancer presenting as a hypopharyngeal metastasis and intraperitoneal dissemination along the tract of a fine-needle biopsy. Lesions undetectable on planar imaging could be visualized by Tc-99m PMT SPECT.
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Affiliation(s)
- N Hayase
- Department of Radiology, Kochi Medical School, Japan.
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Cosenza CA, Sher LS, Poletti BJ, Tschirhart D, Noguchi H, Hoffman AL, Lopez RR, Lugo D, Rojter SE, Makowka L. Metastasis of Hepatocellular Carcinoma to the Right Colon Manifested by Gastrointestinal Bleeding. Am Surg 1999. [DOI: 10.1177/000313489906500306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
An 82-year-old black woman with a history of hepatocellular carcinoma presented with gastrointestinal bleeding. Barium enema and fibrocolonoscopy revealed a 4-cm polypoid mass at the level of the ascending colon with evidence of active bleeding. Biopsies of the lesion proved it to be metastatic hepatocellular carcinoma. Exploratory laparotomy revealed no further dissemination of the tumor, and the patient underwent an ileocolectomy. The serosal side of the colonic lesion was free from tumor, and there was no peritoneal implantation, direct extension, or lymph node involvement. This case represents an extremely rare presentation of metastatic hepatocellular carcinoma.
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Affiliation(s)
- Carlos A. Cosenza
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
| | - Linda S. Sher
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
| | - Bernard J. Poletti
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
| | - Donald Tschirhart
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
| | - Hiroji Noguchi
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
| | - Allen L. Hoffman
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
| | - Richard R. Lopez
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
| | - Diana Lugo
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
| | - Sergio E. Rojter
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
| | - Leonard Makowka
- Comprehensive Liver Disease and Treatment Center and Pathology Department, St. Vincent Medical Center, Los Angeles, California
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Maillefert JF, Tebib J, Quipourt V, Brunotte F, Michiels C, Hillon P, Tavernier C. Normal technetium 99m diphosphonate bone scintigraphy in skeletal metastases from hepatocellular carcinoma. J Hepatol 1994; 21:684. [PMID: 7814817 DOI: 10.1016/s0168-8278(94)80120-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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