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Zhao X, Guo X, Zhao Y, Yu Y. Gastrointestinal Bleeding Was Diagnosed as Small Intestinal Metastasis of Hepatocellular Carcinoma by Double-Balloon Enteroscopy. Dig Dis Sci 2024; 69:1515-1516. [PMID: 38381225 DOI: 10.1007/s10620-024-08339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Xiaohan Zhao
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong Province, 250012, China
| | - Xinrui Guo
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong Province, 250012, China
| | - Ying Zhao
- Department of Geriatrics, Jinan Military General Hospital, Jinan, Shandong Province, China
| | - Yanbo Yu
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong Province, 250012, China.
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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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Gastrointestinal tract involvement in hepatocellular carcinoma: two cases illustrating duodenal and oesophageal invasion. Acta Gastroenterol Belg 2021; 84:660-662. [PMID: 34965048 DOI: 10.51821/84.4.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present here two hepatocellular carcinoma (HCC) patients with gastrointestinal tract involvement (GITI). Hemorrhage due to duodenal involvement was the inaugural event of the HCC for the first patient. Dysphagia due to HCC recurrence in the oesophagus four years after left hepatectomy was the call symptom for the second. As incidence of HCC increases, and overall survival improves, incidence of GITI in HCC patients is expected to increase.
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Ito T, Hirose T, Matsumoto A, Yogo A, Okuno T, Doi R. Hepatocellular carcinoma with duodenal invasion resected subsequent to multimodal therapies: A case report. Int J Surg Case Rep 2019; 60:348-352. [PMID: 31284223 PMCID: PMC6614111 DOI: 10.1016/j.ijscr.2019.06.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 11/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) with duodenal invasion is a very rare occurrence. Aggravated disease condition of HCC with duodenal invasion usually makes surgical treatment not advisable. We present the first case of HCC with duodenal invasion resected following a multimodal therapy that included sorafenib. Partial hepatectomy in conjunction with partial duodenectomy was selected to lessen surgical stress. Surgical resection should be taken into consideration as a therapeutic choice even in progressive HCC disease condition.
Introduction Gastrointestinal (GI) involvement in hepatocellular carcinoma (HCC) is uncommon. In particular, HCC with duodenal invasion is known to be a rare condition. In such cases, surgical indication has been generally negative except in few reported cases. To our knowledge, this report describes the first case of HCC with duodenal invasion, resected by hepatectomy accompanied by pancreas-preserving partial duodenectomy (HPPD) following multimodal therapies including systemic sorafenib administration. Case presentation A 65-year-old man had been repeatedly treated for multiple HCCs by transarterial chemoembolization (TACE) and sorafenib. However, the main tumor formerly ruptured began to involve his duodenum, causing GI bleeding. The collateral vessels from the pancreatic and omental branches entered the tumor and nullified the transarterial hemostatic embolization. Hence, HPPD was performed to preserve the major Vater papilla. Histopathological examination revealed poorly-to -moderately differentiated HCC cells invading the duodenum. Discussion and conclusion HPPD treatment successfully removed HCC with duodenal invasion achieving viable tumor clearance status (R0). We underline the importance of achieving viable tumor clearance status at any time during the treatment course of patients with advanced HCC as this approach may be the only approach to enable HCC patients with duodenal invasion to resume a healthy life.
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Affiliation(s)
- Takashi Ito
- Department of Surgery, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan.
| | - Tetsuro Hirose
- Department of Surgery, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
| | - Atsushi Matsumoto
- Department of Gastroenterology, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
| | - Akitada Yogo
- Department of Surgery, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
| | - Tomoko Okuno
- Department of Pathology, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
| | - Ryuichiro Doi
- Department of Surgery, Otsu Red Cross Hospital, Nagara 1-1-35, Otsu, Shiga, 520-8511, Japan
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Imoto K, Kohjima M, Kurashige T, Mutsuki T, Tashiro S, Suzuki H, Kuwano A, Kato M, Ogawa Y. Successful endoscopic treatment of hepatoduodenal fistula formed during sorafenib treatment for hepatocellular carcinoma with duodenal invasion. ACTA ACUST UNITED AC 2019. [DOI: 10.2957/kanzo.60.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Koji Imoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
| | - Motoyuki Kohjima
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
| | - Tomoyuki Kurashige
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
| | - Taiji Mutsuki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
| | - Shigeki Tashiro
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
| | - Hideo Suzuki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
| | - Akifumi Kuwano
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
| | - Masaki Kato
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
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Hofland J, Koch AD, de Herder WW. Melena in a Patient With a Metastasized Neuroendocrine Tumor. Gastroenterology 2018; 154:e6-e7. [PMID: 28712751 DOI: 10.1053/j.gastro.2017.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 12/02/2022]
Affiliation(s)
- Johannes Hofland
- Section of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands
| | - Wouter W de Herder
- Section of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
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Coelho R, Orfão B, Santos-Antunes J, Rodrigues-Pinto E, Pereira P, Baldaia H, Macedo G. Upper Gastrointestinal Hemorrhage as an Unexpected Feature of Hepatocellular Carcinoma. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:172-174. [PMID: 28868400 PMCID: PMC5580097 DOI: 10.1016/j.jpge.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Rosa Coelho
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Branca Orfão
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | | | | | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Helena Baldaia
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
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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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