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(a) Tumor cells show eosinophilic granular cytoplasm and large nuclei containing prominent nucleoli, resembling HCC (HE, 400×). (b) Tumor cells are positive for alpha-fetoprotein. (c) Positive results for hepatocytes.
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Introduction:
Hepatocellular carcinoma (HCC) is a major cause of cancer-related deaths around the world. Nearly half of patients with HCC display metastatic disease at the time of initial diagnosis, frequently involving the liver, bone, brain, lungs, and adrenal glands, but gastrointestinal involvement is rare. Melena occurring secondary to a meta...
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Context 1
... 5 days of conservative management, segmental small bowel resection and end-to-end anastomosis were performed. Macroscopic examination of the surgical spec- imen showed multiple luminal protruding submucosal masses with extension to the subserosa (Fig. 2). The histological appear- ances were considered typical for moderately differentiated HCC (Fig. 3). These findings supported HCC metastasis to the small ...Similar publications
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Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by multiple recurrent vascular malformations, including hemangioma, which primarily locate on the skin and gastrointestinal (GI) tract. The present study reports a 22-year-old female with iron-deficiency anemia and recurrent episodes of melena. The patient also exhibited chara...
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Citations
... diagnosis is delayed because symptoms are non-specic and small intestine is not totally accessible to endoscopic examination. It usually manifests t h r o u g h c o m p l i c a t i o n l i k e o c c l u s i o n ( 4 0 % ) o r bleeding(24%) [6]. Small bowel tumors are often not visualized by both upper GI endoscopy and colonoscopy in the rst instance, and further investigations to visualise the small bowel are crucial, generally in the form of magnetic resonance enterography, CT colonography or wireless capsule endoscopy, which have all been shown to be effective in reaching the diagnosis. ...
Small bowel adenocarcinoma (SBA) is extremely rare. The incidence of SBA is very low as compared to large bowel adenocarcinoma and it is diagnosed in advanced stages because of lack of specic signs and symptoms in its presentation. Small bowel adenocarcinoma can also run in families, even if there is no conclusive literature as is available for large bowel adenocarcinoma. We encountered a rare case of adenocarcinoma of jejunum in a 34years male which was diagnosed by CECT abdomen. His father also had adenocarcinoma of jejunum 16 years back. A high index of suspicion is required to make the diagnosis of small bowel adenocarcinoma in suspected cases
... These can be diagnosed with capsule endoscopy (CE) and managed with deep enteroscopy (spiral, single or double balloon). Kunizaki et al [45] described a case where a patient with metastatic HCC developed OGIB secondary to a small bowel metastatic lesion diagnosed with double balloon enteroscopy (DBE). ...
Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection and/or treatment with local ablative techniques or chemotherapy. However, even with different screening programs, more than 60% of tumors are still detected at an advanced stage, leading to an unchanged mortality rate, thereby implying a room for improvement in the screening and diagnostic process. In the last few years, there has been evolution of utility of endoscopy, specifically endoscopic ultrasonography along with Fine needle aspiration, for this purpose, which we comprehensively review in this article.
... Small bowel tumors are often not visualized by both esophagogastroduodenoscopy and colonoscopy in the first instance, and further investigations to visualise the small bowel are crucial, generally in the form of magnetic resonance enterography, CT colonography or wireless capsule endoscopy, which have all been shown to be effective in reaching the diagnosis (16). The treatment of small bowel adenocarcinoma remains centered around radical surgical resection (6). ...
Small bowel adenocarcinoma is part of the tumor spectrum of Lynch syndrome, which is caused by germline mutations in the mismatch repair genes. The present study describes the case of a 51-year-old man fulfilling the Amsterdam II criteria for Lynch syndrome, who had a 15-mm early-stage colorectal cancer resected endoscopically from the ascending colon. Due to upper abdominal discomfort after eating and consequent anorexia, a computed tomography scan performed 1 month later showed a tumoral mass of the upper jejunum with local lymphadenopathy. The laparotomy revealed a completely obstructing mass. Intraoperative frozen section showed a small bowel adenocarcinoma. Subsequent genetic testing confirmed the germline mutation of mutL homolog 1. The patient received 6 cycles of an adjuvant folinic acid, fluorouracil and ocaliplatin chemotherapy regimen. The latest CT scan, 16 months after the chemotherapy, did not show any recurrence. This case highlights the importance of considering the possibility of small bowel adenocarcinoma in patients with upper bowel obstruction, particularly for patients with Lynch syndrome.
... Endoscopic findings of gastrointestinal metastasis from HCC vary, but include raised and centrally ulcerated lesions, polypoid tumors and submucosal tumors [2,4]. Several reported cases of small bowel metastasis have been diagnosed using CE and DBE [5][6][7][8][9][10][11]. However, only one case of small bowel metastasis from HCC diagnosed by DBE has been reported [5]. ...
... Several reported cases of small bowel metastasis have been diagnosed using CE and DBE [5][6][7][8][9][10][11]. However, only one case of small bowel metastasis from HCC diagnosed by DBE has been reported [5]. Honda et al. [12] reported that CT and fluoroscopic enteroclysis had significantly lower diagnostic yields of small bowel tumors ≤10 mm in size, but CE and DBE had high yields of small bowel tumors regardless of size. ...
We report a rare case of metastasis of hepatocellular carcinoma (HCC) to the small bowel that presented as a pedunculated epithelial polyp. A 60-year-old man with liver cirrhosis type B was treated for HCC (stage IVb) at our hospital. He had been admitted for melena and anemia. Capsule endoscopy was performed in this patient with obscure gastrointestinal bleeding. It showed a polypoid lesion with bleeding in the ileum. Double-balloon endoscopy was performed. The lesion was determined to be a pedunculated polyp in the ileum. Histological examination of biopsy specimens showed tumor cells resembling HCC. We performed endoscopic mucosal resection for the lesion by double-balloon endoscopy to prevent bleeding from the tumor. The patient had no melena or anemia and his condition improved after endoscopic mucosal resection. However, he died of liver failure 2 months later.
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.
Hepatocellular carcinoma (HCC) is a highly invasive malignancy that frequently invades small and large blood vessels, the liver substance, and bile ducts. In contrast to cholangiocarcinoma, perineural and intraneural invasion is a less common invasion mode of HCC. Invasion of the portal vein, with or without associated venous thrombosis, is a typical feature of HCC and plays a central role in intrahepatic tumor spread. Hepatic microvascular invasion is more frequently observed in HCCs with a lower degree of differentiation and confers an aggressive tumor biology. HCCs with extranodular growth and contiguous multinodular growth patterns are prone to microvascular invasion. HCCs give rise to intrahepatic and remote metastases with high frequency. Risk factors for metastasis comprise macro- and microvascular invasion, large tumor size, multifocality, and poor histologic differentiation. Intrahepatic metastases, which may occur in more than 80 % of large tumors, appear as macro- or micrometastases. Extrahepatic metastases are predominantly found in the lung, bone, lymph nodes, and brain, followed by the gastrointestinal tract and other sites.
In September 2003, a double-balloon endoscope (DBE) composed of balloons attached to a scope and an overtube was released in Japan prior to becoming available in other parts of the world. The DBE was developed by Dr. Yamamoto (1), and 5 different types of scopes with different uses have already been marketed. In April 2007, a single-balloon small intestinal endoscope was released with a balloon attached only to the overtube as a subsequent model. This article presents a detailed account of the development of these scopes up to the present time.
Background:
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver.
Aims:
The aim of this study was to describe the prevalence, trends, and predictors of metastatic HCC on a national scale.
Methods:
We used two nationwide datasets for our study: the University Health Consortium (UHC) and the Nationwide Inpatient Sample (NIS) databases. We included adults with a primary diagnosis of HCC from 2000 to 2011. We collected information regarding demographics, insurance, HCC risk factors, liver decompensation, and the sites and frequencies of metastases. Multivariable regression analysis was used to examine predictors of metastatic HCC. Trend analysis was performed to examine the change in metastatic HCC prevalence over time.
Results:
We included 25,671 and 26,054 HCC patients from UHC and NIS, respectively. Prevalence of metastatic HCC was 18 % with lung being the most frequent site (31 %). Compared with Caucasian, African American ethnicity was an independent predictor of metastasis in both the NIS [OR 1.13 (1.02-1.25)] and UHC [OR 1.4 (1.3-1.6)] databases. Lack of long-term insurance was associated with significantly higher prevalence of metastasis in both the NIS [OR 1.6 (1.4-1.9)] and UHC [OR 1.9 (1.6-2.2)] databases. There has been an increased prevalence of metastatic HCC over the last decade with an annual percentage change of +1.25 and +1.60 % (p = 0.03 and p = 0.08) for the NIS and UHC databases, respectively.
Conclusions:
Metastasis is not rare among HCC patients and is rising in prevalence over the last decade. Lungs were the most common metastatic site. Ethnicity and insurance status are independent predictors of metastasis.
