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

Abstract

Hepatocellular Carcinoma (HCC) is a common malignancy worldwide. While bleeding from the gastrointestinal tract (BGIT) has a well known association with HCC, such cases are mainly due to gastric and esophageal varices. BGIT as a result of invasion of the gastrointestinal tract by HCC is extremely rare and is reportedly associated with very poor prognosis. We describe a 67-year-old male who presented with BGIT. Endoscopy showed the site of bleeding to be from a gastric ulcer, but endoscopic therapy failed to control the bleeding and emergency surgery was required. At surgery, the ulcer was found to have arisen from direct invasion of the gastrointestinal tract by HCC of the left lobe. Control of the bleeding was achieved by surgical resection of the HCC enbloc with the lesser curve of the stomach. The patient remains alive 33 mo after surgery. Direct invasion of the gastrointestinal tract by HCC giving rise to BGIT is very uncommon. Surgical resection may offer significantly better survival over non-surgical therapy, especially if the patient is a good surgical candidate and has adequate functional liver reserves. Prognosis is not uniformly grave.

Clinicopathological features and differential diagnosis of gastric metastases

“…Immunohistochemistry showed that tumor cells expressed neuroendocrine markers (CD56, CgA, or Syn), TTF-1, and CK [ 19 , 20 ]. In some cases, immunohistochemical assistance is limited, such as gastric metastases of hepatocellular carcinoma and primary hepatoid adenocarcinoma [ 21 ]. It should be noted that there may be a loss of immunophenotype during tumor metastasis.…”

Direct biliopancreatoduodenal invasion by hepatocellular carcinoma: report of the first resected case and review of the literature

“…A review of the English-language literature as well as Japanese reports with English abstracts identified 17 previous cases with sufficient details in which combined resection of the liver and involved GI organs was carried out [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Clinicopathological features of the 18 cases including ours are summarized in Table 1.…”

Renal Invasion Of Hepatocellular Carcinoma: Report Of A Case

“…Extrahepatic metastases are usually associated with the advanced disease and there are only palliative treatment choices such as chemotheraphy or transcatheter chemoembolization for these patients (1,2). Extrahepatic tumor growth with direct invasion of adjacent structures is rarely reported in the literature (3)(4)(5)(6)(7)(8)(9). Inadequate assessment before surgery, preoperatively missed occult tumors, insufficient therapy, insufficient tumor resection or the aggresive nature of the tumor may lead to early recurrence after treatment.…”