A prospective study of upper gastrointestinal hemorrhage in patients with hepatocellular carcinoma

Abstract

Our purpose was to determine, in a prospective study, the causes of gastrointestinal hemorrhage in patients with hepatocellular carcinoma, and the relationship of portal vein invasion with variceal hemorrhage in these patients. During an 11-month period, 55 patients presented with hepatocellular carcinoma presented with signs and/or symptoms of upper gastrointestinal hemorrhage. Forty-seven percent had bleeding from varices, whereas the majority, 53%, had a nonvariceal bleeding source. Among those with nonvariceal bleeding, duodenal ulceration was the commonest cause. Direct tumor invasion into the gastrointestinal tract was found in three patients. Tumor invasion of the portal venous system was detected by ultrasound examination in 76% of the variceal bleeders, compared to only 45% of the nonvariceal bleeders. Despite the very high frequency of cirrhosis among patients with hepatocellular carcinoma, the source of bleeding was variceal in less than half of the patients. Portal vein invasion is a risk factor for subsequent variceal bleed.

Successful en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas

“…These specific features of HCC mean that it rarely infiltrates the gastrointestinal (GI) tract directly. The incidence is reported to be 0.5% to 2% of clinical HCC cases [1,2] . Whether such an invasion causes massive hemorrhage or obstruction, a complete en bloc resection of these extensive HCCs can be safely performed using modern surgical techniques and sophisticated perioperative management.…”

Hepatocellular carcinoma masquerading as a bleeding gastric ulcer: A case report and a review of the surgical management

“…In a clinical study, Chen et al [12] reported 8 out of 396 patients (2%) with HCC who developed gastrointestinal involvement during the course of the disease. Lin et al [2,[6][7][8][9][10][11][12] similarly reported gastrointestinal metastases in 11 out of 2237 patients with HCC (0.5%). Only 10 cases of HCC invading directly into the stomach could be found in the literature.…”

“…Of these 10 cases reported [2,[6][7][8][9][10][11][12] , 6 had received some form of regional therapy, such as trans-arterial chemoembolization (TACE), intra-arterial chemotherapy or radiotherapy, either alone or in combination, prior to the HCC invading the gastro-intestinal tract. This includes 4 of the 5 patients with direct invasion of the gastrointestinal tract by contiguous HCC reported by Chen et al [12] .…”

“…Bleeding from the gastrointestinal tract (BGIT) is a common complication of HCC and a frequent cause of death from this disease. Most cases of BGIT are due to esophageal and gastric varices [2] and the rest are mainly due to peptic ulcers. However, invasion of the gastrointestinal tract by HCC, through metastasis or direct invasion, is found in only 4-12% of cases at autopsy [3][4][5]12] .…”

“…Direct invasion of the stomach by HCC is extremely rare. A detailed literature review showed only 10 cases of HCC with direct or contiguous invasion of the stomach have been reported [2,[6][7][8][9][10][11][12] . We describe the case of a 67-year-old Chinese man with this uncommon clinical entity, who presented with BGIT and was managed by surgical resection.…”