Direct invasion to the colon by hepatocellular carcinoma: Report of two cases

Abstract

Although hepatocellular carcinoma (HCC) is a common tumor, direct invasion of the gastrointestinal tract by HCC is uncommon. Recently, we encountered two cases of HCC with direct invasion to the colon. The first patient was a 79-year-old man who underwent transarterial chemo-embolization (TACE) for HCC 1.5 years prior to admission to our hospital. Computed tomography (CT) showed a 7.5-cm liver tumor directly invading the transverse colon. Partial resection of the liver and transverse colon was performed. The patient survived 6 mo after surgery, but died of recurrent HCC. The second patient was a 69-year-old man who underwent TACE and ablation for HCC 2 years and 7 months prior to being admitted to our hospital for melena and abdominal distension. CT revealed a 6-cm liver tumor with direct invasion to the colon. The patient underwent partial resection of the liver and right hemicolectomy. The patient recovered from the surgery. But, unfortunately, he died of liver failure due to liver cirrhosis one month later. Although the prognosis of HCC that has invaded the colon is generally poor due to the advanced stage of the disease, surgical resection may be a favorable treatment option in patients with a good general condition.

Hepatocellular carcinoma presenting as a huge intra-abdominal mass: A case report

“…Although this occurrence was observed in approximately 10% of patients with HCC in a study of postmortem examinations, the incidence is reported to be 0.5% and 2% of clinical HCC cases (6,7). The organs involved included the duodenum, stomach, colon, or jejunum (8).…”

Hepatocellular carcinoma with colonic metastasis

“…When intrahepatic lesions are well controlled and in good hepatic reserve, symptomatic or life-threatening metastasis should be treated. (2,3) RFA is technically difficult because of its high risk of perforation, (11) and TAE and TACE are not effective in treating HCC with GI tract metastasis. (11) Surgical resection may be the most effective treatment option for GI tract metastasis of HCC.…”

“…(2,3) RFA is technically difficult because of its high risk of perforation, (11) and TAE and TACE are not effective in treating HCC with GI tract metastasis. (11) Surgical resection may be the most effective treatment option for GI tract metastasis of HCC. According to Fujii et al, the median survival time of patients with GI tract invasion treated using surgical resection is longer than those who receive nonsurgical and supportive treatment.…”

“…(7)(8)(9) Bloody stool is the most frequent symptom of colonic metastasis. (11) The treatment of HCC depends on the tumour stage. Primary HCC or intrahepatic metastasis can be treated using curative resection, RFA, PEI, TAE and TACE.…”

“…(2,3,5) Hirashita et al, in a recent case series, reported that the median survival of HCC patients with colonic metastasis was only 2.5 months. (11) Predictors for poor prognosis included performance status and intrahepatic lesion controllability. (3,5) Patients with extrahepatic metastases generally have more advanced intrahepatic tumours or vessel invasion when first diagnosed with HCC.…”