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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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2
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Hot S, Yeşiltaş M, Gökçek B, Eğin S, Şengiz S. Massive and life-threatening upper gastrointestinal bleeding due to invasive hepatocellular carcinoma: A case report. Int J Surg Case Rep 2016; 26:69-72. [PMID: 27455113 PMCID: PMC4961499 DOI: 10.1016/j.ijscr.2016.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 01/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC), which constitutes more than 90% of primary liver cancers, is a major global health problem. In HCC, 30% of cancer related deaths is due to hepatic failure, and 10% is due to gastrointestinal (GI) bleeding. GI metastasis is reported as 0.4-2%. GI bleeding frequency due to HCC direct invasion is 0.05-2%, and may be fatal. Besides, the repetition of TAE, intra-arterial chemotherapy, radiotherapy, and individualized treatment plans have recently increased survival in unresectable HCC patients, and thus it is expected that GI involvement will be more commonly encountered in HCC patients in the near future.
Background The mean survival is less than 6 months in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. Gastrointestinal(GI) bleeding frequency due to HCC invasion is 0.05% to 2.0%, and may be fatal. Case presentation We encountered a case of HCC with direct invasion to the gastrium that caused a life-threatening upper GI bleeding. Our patient was a 62 year old male who was a heavy smoker and drinker for almost 30 years. He had several upper GI bleeding episodes during the previous 6 months. Computed tomography (CT) revealed a 13 cm liver tumour directly invading the gastrium. Partial hepatic resection and subtotal gastrectomy were performed. Unfortunately, the patient died at the intensive care unit postoperatively due to hepatic failure. Discussion Although the prognosis of HCC that has invaded the gastrium is very poor due to the advanced stage of the disease, surgical resection may be a favourable treatment option for patients with a massive upper GI bleeding. Conclusions The incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue.
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Affiliation(s)
- Semih Hot
- General Surgery Dep., Okmeydanı Training Research Hospital, İstanbul, Turkey.
| | - Metin Yeşiltaş
- General Surgery Dep., Okmeydanı Training Research Hospital, İstanbul, Turkey.
| | - Berk Gökçek
- General Surgery Dep., Okmeydanı Training Research Hospital, İstanbul, Turkey.
| | - Seracettin Eğin
- General Surgery Dep., Okmeydanı Training Research Hospital, İstanbul, Turkey.
| | - Selma Şengiz
- Pathology Department, Okmeydanı Training Research Hospital, İstanbul, Turkey.
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3
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Li L, Zhang WH, Meng FP, Ma XM, Shen LJ, Jin B, Li HW, Han J, Zhou GD, Liu SH. Gastric Metastasis of Hepatocellular Carcinoma With Gastrointestinal Bleeding After Liver Transplant: A Case Report. Transplant Proc 2016; 47:2544-7. [PMID: 26518968 DOI: 10.1016/j.transproceed.2015.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/02/2015] [Indexed: 01/20/2023]
Abstract
Gastrointestinal (GI) metastasis of hepatocellular carcinoma is very rare. This is the first report of post-transplantation gastric metastasis. A 43-year-old man with a history of hepatitis B-related hepatocellular carcinoma (HCC) in the right anterior segment of the liver received an orthotopic liver transplant. Three months after the transplantation, pulmonary metastasis was found by chest computed tomography, and he received 1 course of gamma knife treatment. He complained of melena with anemia 17 months post liver transplantation. Abdominal CT scan showed new occupying lesions in the liver and a mass in the stomach and around the spleen with embolus in the splenic vein. Endoscopy revealed a large irregular cauliflower-like mass in fundus with ulceration and bleeding on the surface. He received symptomatic treatment, but died of cancer-related bleeding 4 months later. GI bleeding may due to gastric metastasis after liver transplantation.
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Affiliation(s)
- L Li
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - W H Zhang
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - F P Meng
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - X M Ma
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - L J Shen
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - B Jin
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - H W Li
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China.
| | - J Han
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - G D Zhou
- Department of Pathology, 302 Military Hospital of China, Beijing, China
| | - S H Liu
- Department of Pathology, 302 Military Hospital of China, Beijing, China
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Hassanien M, El-Talkawy MD, El-Ghannam M, El Ray A, Ali AA, Taleb HA. Predictors of In-Hospital Mortality in patients with hepatocellular carcinoma and Acute Variceal bleeding. Electron Physician 2015; 7:1336-43. [PMID: 26516439 PMCID: PMC4623792 DOI: 10.14661/1336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/25/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction Detection of hepatocellular carcinoma (HCC) in cirrhotic patients remains a serious, unsolved problem, and the risk factors for acute variceal bleeding (AVB) in HCC patients remain unclear. This study aimed to determine the in-hospital mortality (IHM) and factors influencing the clinical outcomes of AVB in patients with liver cirrhosis and HCC. Methods This was a retrospective, non-randomized, clinical study that was conducted in 2014. The study was conducted on 70 patients with liver cirrhosis and HCC presenting by acute upper gastrointestinal bleeding (AUGIH). All patients were examined endoscopically within 24 hours from presentation and bleeding varices accounted for AUGIH. Full medical history, clinical examination, and laboratory and radiologic data were collected from admission charts, and hospital medical records were statistically analyzed with SSPS version 22. Results Thirty-two patients (45.7%) survived and 38 died (54.3%). Survivors are more likely to be Child-Pugh class A or B, and the non-survivors were class C. The Model for End-Stage Liver Disease (MELD) was highly predictive of IHM at an optimized cut-off value of ≥ 12.9. Higher esophageal varices grades and presence of active bleeding on index endoscopy were significant (p < 0.01) in the non-survivors compared to survivors. Complications of liver cirrhosis and associated major comorbidity were significantly higher (p < 0.01) in the non-survivors than the survivors. Univariate logistic regression analysis identified higher Grade Esophageal Varices and number of transfused packed red blood cells units as two independent predictors of IHM. Conclusions IHM was particularly high (54.3%) among HCC patients with AVB who had MELD score > 12.9, higher grade Esophageal Varices, active bleeding on index endoscopy, more increased needs for blood transfusion, longer hospital stay, decompensated liver disease with major comorbidity.
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Affiliation(s)
- Moataz Hassanien
- Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Mohamed Darwish El-Talkawy
- Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Maged El-Ghannam
- Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed El Ray
- Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Abdel Aziz Ali
- Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt
| | - Hoda Abu Taleb
- Biostatistics and Demography, Medical Statistician, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt
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5
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Significance of serum angiogenin assay as a novel marker for diagnosis of hepatocellular carcinoma in liver cirrhosis. EGYPTIAN LIVER JOURNAL 2015. [DOI: 10.1097/01.elx.0000459080.18855.50s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Grover I, Ahmad N, Googe AB. Hepatogastric Fistula following Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma. Case Rep Gastroenterol 2014; 8:286-90. [PMID: 25408632 PMCID: PMC4224249 DOI: 10.1159/000368302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Hepatogastric fistula (HGF) formation following transcatheter arterial chemoembolization (TACE) leads to increased morbidity and mortality. A 51-year-old Caucasian male with chronic hepatitis B virus-associated cirrhosis and unresectable hepatocellular carcinoma (HCC) presented to the Interventional Radiology Unit for TACE to achieve tumor necrosis. Following the procedure, the patient was admitted with symptoms of fever, epigastric and right upper quadrant pain secondary to the development of an abscess. The abscess was drained; however, an exceedingly rare HGF resulted that was favored to represent a direct invasion of HCC. HGF, the rare complication following TACE, leads to grave consequences and vigilant monitoring, for the development of this entity is recommended to reduce patient mortality. We present a case and literature review of HGF development following TACE for HCC.
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Affiliation(s)
- Inderpreet Grover
- Internal Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Miss., USA
| | - Naveed Ahmad
- Department of Gastroenterology, Indiana University Health Arnett, Lafayette, Ind., USA
| | - Amber B Googe
- University of Mississippi Medical Center, Jackson, Miss., USA
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Sayana H, Yousef O, Clarkston WK. Massive upper gastrointestinal hemorrhage due to invasive hepatocellular carcinoma and hepato-gastric fistula. World J Gastroenterol 2013; 19:7472-7475. [PMID: 24259980 PMCID: PMC3831231 DOI: 10.3748/wjg.v19.i42.7472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
A 36-year-old male Asian immigrant with a history of hepatitis B and hepatitis C related unresectable hepatocellular carcinoma in the left lobe of the liver presented with hematemesis and severe anemia. He was diagnosed with a liver mass that was resected 8 years ago described as a benign tumor in his home country. He had received trans-arterial chemoembolization (TACE) four months ago after subsequent diagnosis of unresectable hepatoma, and currently was receiving chemotherapy with Sorafenib. After resuscitation, a contrast enhanced computerized tomography was performed which showed fistulization of hepatocellular carcinoma into adjacent stomach. This finding was confirmed during endoscopy with direct visualization of the fistulous opening. Hepatocellular carcinoma (HCC) invading the gastrointestinal (GI) tract is rare. We present a case and literature review of HCC with local invasion of the stomach causing massive upper GI bleeding after receiving TACE.
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Lin TL, Yap AQ, Wang JH, Chen CL, Iyer SG, Low JK, Lin CC, Li WF, Chen TY, Bora D, Lin CY, Wang CC. Long term survival in patients with hepatocellular carcinoma directly invading the gastrointestinal tract: case reports and literature review. Surg Oncol 2011; 20:e207-14. [PMID: 21824763 DOI: 10.1016/j.suronc.2011.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/09/2011] [Accepted: 06/29/2011] [Indexed: 01/28/2023]
Abstract
Hepatocellular carcinoma (HCC) directly invading the gastrointestinal (GI) organs is rare and is associated with poor survival outcome. We report two patients with good long-term outcome following resection of HCC that invaded the stomach and duodenum, respectively. A literature review was conducted to elucidate the course of patients with this pathology. Two cases (57-year-old and 72-year-old males) with enlarged hepatic tumors directly invading the stomach and duodenum underwent hepatectomies with en-bloc resection of the involved organs. Both patients are still alive at 80 and 68 months following the surgery. Our literature review showed that most of the patients with this pathology have manifested, and died of persistent GI bleeding. Patients who were treated surgically had a statistically significant longer survival than those who were treated with non-surgical palliative treatments (P < 0.001). In addition, patients who were treated with surgery with curative intent tend to have a longer survival times than those who were treated with surgery to palliate the bleeding but the difference was not statistically significant (P < 0.174). Removing the tumor completely could significantly prolong the survival of patients with HCC invading the GI tract.
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Affiliation(s)
- Ting-Lung Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
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9
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Park H, Kim SU, Choi J, Park JY, Ahn SH, Han KH, Chon CY, Park YN, Kim DY. Hepatogastric fistula caused by direct invasion of hepatocellular carcinoma after transarterial chemoembolization and radiotherapy. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 16:401-4. [PMID: 21415585 PMCID: PMC3304605 DOI: 10.3350/kjhep.2010.16.4.401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 63-year-old man with a history of hepatitis-B-related hepatocellular carcinoma (HCC) in the left lateral portion of the liver received repeated transcatheter arterial chemoembolization (TACE) and salvage radiotherapy. Two months after completing radiotherapy, he presented with dysphagia, epigastric pain, and a protruding abdominal mass. Computed tomography showed that the bulging mass was directly invading the adjacent stomach. Endoscopy revealed a fistula from the HCC invading the stomach. Although the size of the mass had decreased with the drainage through the fistula, and his symptoms had gradually improved, he died of cancer-related bleeding and hepatic failure. This represents a case in which an HCC invaded the stomach and caused a hepatogastric fistula after repeated TACE and salvage radiotherapy.
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Affiliation(s)
- Hana Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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10
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Kato Y, Matsubara K, Akiyama Y, Hattori H, Hirata A, Yamamoto T, Suzuki F, Ohtaka H, Sugiura Y, Kitajima M. Direct biliopancreatoduodenal invasion by hepatocellular carcinoma: report of the first resected case and review of the literature. Int J Clin Oncol 2010; 16:421-7. [DOI: 10.1007/s10147-010-0136-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 09/09/2010] [Indexed: 12/21/2022]
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11
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Korkolis DP, Aggeli C, Plataniotis GD, Gontikakis E, Zerbinis H, Papantoniou N, Xinopoulos D, Apostolikas N, Vassilopoulos PP. Successful en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas. World J Gastroenterol 2009; 15:1134-7. [PMID: 19266609 PMCID: PMC2655177 DOI: 10.3748/wjg.15.1134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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
Multivisceral surgical resection for cure was successfully performed in a 70-year-old man suffering from a primary hepatocellular carcinoma (HCC) associated with direct invasion to the stomach and pancreas. The patient presented with gastric outlet obstruction, upper abdominal pain and a history of chronic liver disease due to hepatitis B virus (HBV) infection. Upper gastrointestinal (GI) endoscopy revealed an infiltrating tumor protruding through the gastric wall and obliterating the lumen. Computer tomograghy (CT) and magnetic resonance imaging (MRI) scan demonstrated a 15-cm tumor in the left lateral segment of the liver with invasion to the stomach and pancreas. Alpha-foetoprotein (AFP) levels and liver function tests were normal. The patient underwent an en bloc left hepatectomy, total gastrectomy, distal pancreatectomy with splenectomy and radical lymphadenectomy. Pathology revealed a poorly differentiated, giant cell HCC involving the stomach and pancreas. Disease-free margins of resection were achieved. The patient’s postoperative course was uneventful. Sixteen months after surgery, he has no recurrence or distal metastasis. Direct invasion of HCC into the GI tract is rarely encountered. Complete surgical resection should be considered in selected patients with an appropriate hepatic functional reserve.
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12
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Ong JCA, Chow PKH, Chan WH, Chung AYF, Thng CH, Wong WK. Hepatocellular carcinoma masquerading as a bleeding gastric ulcer: A case report and a review of the surgical management. World J Gastroenterol 2007; 13:4523-5. [PMID: 17724814 PMCID: PMC4611591 DOI: 10.3748/wjg.v13.i33.4523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular Carcinoma (HCC) is a common malignancy worldwide. While bleeding from the gastrointestinal tract (BGIT) has a well known association with HCC, such cases are mainly due to gastric and esophageal varices. BGIT as a result of invasion of the gastrointestinal tract by HCC is extremely rare and is reportedly associated with very poor prognosis. We describe a 67-year-old male who presented with BGIT. Endoscopy showed the site of bleeding to be from a gastric ulcer, but endoscopic therapy failed to control the bleeding and emergency surgery was required. At surgery, the ulcer was found to have arisen from direct invasion of the gastrointestinal tract by HCC of the left lobe. Control of the bleeding was achieved by surgical resection of the HCC en-bloc with the lesser curve of the stomach. The patient remains alive 33 mo after surgery. Direct invasion of the gastrointestinal tract by HCC giving rise to BGIT is very uncommon. Surgical resection may offer significantly better survival over non-surgical therapy, especially if the patient is a good surgical candidate and has adequate functional liver reserves. Prognosis is not uniformly grave.
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Affiliation(s)
- Johnny C A Ong
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore, Singapore
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13
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Inoue H, Sawada Y, Ochiai K, Honda H, Murayama J, Kudo Y, Nakashima Y, Sagihara N, Miyatani H, Nakamura I, Yoshida Y. Hepatocellular carcinoma with direct invasion to the stomach. Intern Med 2007; 46:845-8. [PMID: 17575376 DOI: 10.2169/internalmedicine.46.6048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 71-year-old man was admitted to our hospital with abdominal pain. Hepatocellular carcinoma (HCC) had been diagnosed 2 years earlier and he had undergone 7 courses of intra-hepato-arterial chemotherapy (IHAC). We performed gastrointestinal fiberscopy and identified a massive protrusion on the lesser curvature. Abdominal contrast-enhanced computed tomography revealed multiple hepatic masses and an extrahepatic enlarged mass with invasion to the pancreas and stomach. A specimen for endoscopic biopsy revealed adenocarcinoma that stained positive for alpha-fetoprotein. Gastrointestinal bleeding resulting from direct invasion of HCC is unusual.
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Affiliation(s)
- Hiromu Inoue
- Division of Gastroenterology and Department of Integrated Medicine I, Omiya Medical Center, Jichi Medical School, Saitama.
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14
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Ungew�hnliche Komplikation eines hepatozellul�ren Karzinoms. Rechtsmedizin (Berl) 2004. [DOI: 10.1007/s00194-004-0295-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Lin CP, Cheng JS, Lai KH, Lo GH, Hsu PI, Chan HH, Hsu JH, Wang YY, Pan HB, Tseng HH. Gastrointestinal metastasis in hepatocellular carcinoma: radiological and endoscopic studies of 11 cases. J Gastroenterol Hepatol 2000; 15:536-41. [PMID: 10847441 DOI: 10.1046/j.1440-1746.2000.02152.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND From October 1990 to January 1999, 11 of 2237 hepatoma patients at our hospital had gastrointestinal tract metastasis. We describe the radiological and endoscopic features, clinical course and prognoses of those patients. METHODS All patients were male. Six patients were hepatitis B carriers, and cirrhosis was noted in eight patients on admission. We reviewed all available radiological, endoscopic and pathological features. RESULTS The commonest clinical presentation was frank gastrointestinal bleeding. Histological proof of gastrointestinal involvement was seen in six patients. Endoscopic features included ulcerative tumours mimicking advanced gastric carcinoma (43%) and submucosal tumours (29%). The sites of organ involvement were stomach (five), duodenum (two), colon (three) and duodenum and colon (one). Direct invasion by a contiguous neoplasm was the major route of gastrointestinal tract metastasis. Portal vein thrombosis may be the key point of haematogenous spread to other sites. CONCLUSIONS The prognosis in these patients was extremely poor. Almost all patients died within 5 months if no further aggressive management was performed. Surgical intervention may be the optimal choice for palliative treatment of HCC with gastrointestinal tract involvement.
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Affiliation(s)
- C P Lin
- Department of Internal Medicine, Veterans General Hospital-Kaohsiung, National Yang-Ming University, Taiwan, Republic of China
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16
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Hung HC, Huang YS, Lin CC, Chao Y, Chi KH, Yen SH, Chang FY. Radiotherapy in the treatment of duodenal bleeding due to hepatocellular carcinoma invasion. J Gastroenterol Hepatol 1998; 13:1143-5. [PMID: 9870803 DOI: 10.1111/j.1440-1746.1998.tb00591.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Haemorrhage from an hepatocellular carcinoma (HCC) directly invading the gastrointestinal (GI) tract is uncommon. A 58-year-old man was admitted with upper gastrointestinal (UGI) bleeding and panendoscopy on examination revealed a large duodenal ulcerative bleeding mass. The mass was eventually diagnosed as HCC by pathological examination. The bleeding failed to respond to conventional management of haemostasis, but resolved with an external beam of radiotherapy with a total dose of 6000 cGy over a 5 week period. This unusual presentation of UGI bleeding, due to HCC invading the duodenum and treated by radiotherapy, has not been previously reported.
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Affiliation(s)
- H C Hung
- Department of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taiwan
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17
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Okusaka T, Okada S, Ishii H, Nagahama H, Yoshimori M, Yamasaki S, Takayasu K, Kakizoe T, Ochiai A, Shimoda T. Hepatocellular carcinoma with gastrointestinal hemorrhage caused by direct tumor invasion to the duodenum. Jpn J Clin Oncol 1997; 27:343-5. [PMID: 9390214 DOI: 10.1093/jjco/27.5.343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal hemorrhage from hepatocellular carcinoma invading the duodenum is very rare. A 60-year-old man with multiple hepatocellular carcinoma was admitted to our hospital because of massive melena and hematemesis. We succeeded in hemostasis of an esophageal variceal rupture by endoscopic varicial ligation. The duodenum could not be observed endoscopically due to extramural compression to the stomach from the liver tumor. Massive gastrointestinal hemorrhage occurred again and the patient died of hepatic failure. The postmortem examination revealed that the liver tumor had invaded the second portion of the duodenum and perforated into the lumen.
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Affiliation(s)
- T Okusaka
- Department of Internal Medicine, National Cancer Center Hospital, Tokyo, Japan
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18
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Chen CY, Lu CL, Pan CC, Chiang JH, Chang FY, Lee SD. Lower gastrointestinal bleeding from a hepatocellular carcinoma invading the colon. J Clin Gastroenterol 1997; 25:373-5. [PMID: 9412926 DOI: 10.1097/00004836-199707000-00019] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Bleeding from the gastrointestinal tract due to hepatocellular carcinoma invasion is unusual. We describe a 71-year-old man who had bloody stools caused by a hepatocellular carcinoma that directly invaded the transverse colon. The diagnosis was confirmed by colonoscopy and tissue examination. Our patient is the first with lower gastrointestinal bleeding from a hepatocellular carcinoma during the natural course of the tumor.
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Affiliation(s)
- C Y Chen
- Department of Medicine, Pathology, Veterans General Hospital-Taipei, Taiwan
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19
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Hashimoto M, Watanabe G, Matsuda M, Yamamoto T, Tsutsumi K, Tsurumaru M. Case report: gastrointestinal bleeding from a hepatocellular carcinoma invading the transverse colon. J Gastroenterol Hepatol 1996; 11:765-7. [PMID: 8872775 DOI: 10.1111/j.1440-1746.1996.tb00328.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 72-year-old woman with cirrhosis of the liver was treated repeatedly by transcatheter arterial embolization for multifocal hepatocellular carcinomas. She developed gastrointestinal bleeding secondary to direct invasion of the wall of the transverse colon. The diagnosis was made pre-operatively by colonoscopy and the patient was treated successfully. This rare complication of hepatocellular carcinoma was due to the protrusive type of growth exhibited by this tumour and may have been affected by the transcatheter arterial embolization.
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Affiliation(s)
- M Hashimoto
- Department of Surgery, Toranomon Hospital, Tokyo, Japan
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