Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway

Abstract

When cirrhotic patients with portal hypertension have HCC with PVT, a hematogenous pathway can exist for gastric metastasis of tumor thrombi involving hepatofugal flow to the stomach after TAE or EVL apart from the major pathway of direct invasion.

An Unusual Case: Gastric Metastasis of Hepatocellular Carcinoma

“…Gastric metastases are quite rare and most common primary tumors are breast, melanoma and gastrointestinal carcinomas in western countries [4]. Hepatocellular carcinoma with gastrointestinal involvement has been reported in 4-10% of cases and mostly via direct invasion but hematogenous metastasis is rather rare [3]. Wu et al evaluated patients with gastric metastatic lesions and found that among 18 patients, 6 had HCC as primary tumor.…”

“…In another study of 8267 patients with HCC, only seven cases (0.08%) were found to have gastric metastases. Since all had undergone transarterial chemoembolisation or esophageal variceal band ligation, the authors suggested that hepatofugal flow after embolization procedures might have been the causal pathway for gastric metastases [3]. Previously, only one case with gastric metastases of HCC after liver transplantation was reported.…”

“…The most frequent metastatic sites of HCC are lungs, bone, lymph nodes and adrenal glands [1,2]. However, gastrointestinal tract involvement is a rare entity with a poor prognosis and can occur via hematogenous route or direct invasion [3]. Patients with chronic liver disease and HCC have upper endoscopy for various reasons and gastric metastases can be found incidentally, however those with HCC after liver transplantation, gastric metastases can be overlooked.…”

Hepatocellular carcinoma with colonic metastasis

“…(9) The presence of tumour thrombosis in the portal vein may cause a reversal of flow, which possibly serves as the mechanism of haematogenous metastasis of HCC to the GI tract. (9) Transarterial embolisation (TAE) and TACE may also induce elevation of portal venous pressure and backward flow of tumour emboli, (10) and as a result, HCC may invade the adjacent organs, such as the colon, or other parts of the GI tract. Haematogenous metastasis is not related to elevated alpha-fetoprotein, but may be associated with vascular invasion such as portal vein or inferior vena cava invasion.…”

“…A search of the MEDLINE database for the English language literature showed that in recent years, ten patients had been reported to have colonic metastasis from HCC (Table I). (7,(9)(10)(11)(13)(14)(15)(16) A major symptom was bloody stool. The most frequent sites of metastasis were the ascending and transverse colons, suggesting that most HCC colonic metastases would directly invade the adjacent colon.…”