Sigmoid colon metastasis from hepatocellular carcinoma

Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
The Korean Journal of Hepatology 12/2010; 16(4):397-400. DOI: 10.3350/kjhep.2010.16.4.397
Source: PubMed


Hepatocellular carcinoma (HCC) is a major health problem worldwide, and it has a poor prognosis. Extrahepatic metastasis from HCC is not unusual, with direct invasion representing the main spreading mode. Sites that are frequently involved are the lung, bone, and lymph nodes. There are few reports of HCC invading the distant gastrointestinal tract, especially hematogenously. Herein we report a case of sigmoid colon metastasis from HCC. The patient was diagnosed with HCC and treated with transcatheter arterial chemoembolization (TACE). Eighteen months after TACE the patient presented with abdominal pain on the left lower quadrant, and a CT scan showed an enhanced mass on the sigmoid colon. Immunohistochemical staining revealed that a tumor cell was positive for polyclonal carcinoembryonic antigen and weakly positive for hepatocyte antigen, supporting the diagnosis of HCC metastasis. The patient underwent anterior resection for the metastatic HCC.

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    ABSTRACT: Background/aims: Accurate staging of hepatocellular carcinoma (HCC) is critical for guiding optimal treatment, and the presence of extrahepatic metastases (EHM) can seriously affect the optimal choice of treatment in the sorafenib era. However, there is limited data about when and how to screen EHM for newly diagnosed HCC patients, especially for patients without symptoms or signs of EHM. Methodology: We analyzed 314 newly diagnosed HCC patients who had no symptoms or signs of EHM and who had undergone additional modalities. Results: EHM was found in 50 of 314 patients (15.9%). Fifteen of 50 EHM (30%) were missed by conventional modalities but revealed by additional modalities. The frequency of EHM were 0% (0/26), 7.6% (10/131), 25.0% (30/120) and 27.0% (10/37) for the modified UICC stages T1, T2, T3 and T4, respectively (p<0.001). The proportions of EHM detected by additional modalities were 50% (5/10 EHM), 33% (10/30 EHM) and 0% (0/10 EHM) for modified UICC stages T2, T3 and T4, respectively. Conclusions: Application of additional staging modalities resulted in change of HCC stage in a significant proportion of HCC patients beyond modified UICC stage T1 by revealing EHM that had not been detected by conventional modalities.
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