An Unusual Case: Gastric Metastasis of Hepatocellular Carcinoma

Gokce Yildiran ,Omer Dizdar ,Arzu Oguz ,Nadire Kucukoztas ,Samed Rahatli ,Ozgur Harmanci ,Ozden Altundag

doi:10.4172/2165-8048.1000170

Gokce Yildiran , Omer Dizdar + Show 5 more

Open Access

https://doi.org/10.4172/2165-8048.1000170

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Abstract

Introduction: Gastrointestinal tract involvement of hepatocellular carcinoma (HCC) is a rare entity with a poor prognosis and can occur via hematogenous route or direct invasion. Here we report a case with de novo HCC after liver transplantation who had rising alfa-fetoprotein (AFP) levels and was found to have gastric metastases incidentally. Case: A 62 year old man underwent liver transplantation with a diagnosis of hepatocellular carcinoma Three years after the liver transplantation, bone and liver metastasis developed and palliative treatment plan was made. During follow-up AFP levels began to rise subsequently and computed tomography of chest and abdomen revealed stable liver lesions and a suspicious gastric luminal nodule. Upper endoscopy showed polypoid lesions in stomach and the pathology of the biopsies taken from these lesions were consistent with HCC metastasis. Discussion: Patterns of metastases in patients with recurrent HCC after liver transplantation might be different. Immunsuppressive treatment in transplant patients might have a negative effect on disease biology and may result in more disseminated disease and atypical sites of metastases as in our case. In patients with rising AFP in the absence of progressive disease on radiologic evaluation, gastrointestinal system metastases via hematogenous route should be kept in mind and upper endoscopy should be considered even in the absence of gastric symptoms, particularly if the presence of extrahepatic disease will change treatment decisions.

Highlights

DiscussionPatterns of metastases in patients with recurrent hepatocellular carcinoma (HCC) after liver transplantation might be different
Gastrointestinal tract involvement of hepatocellular carcinoma (HCC) is a rare entity with a poor prognosis and can occur via hematogenous route or direct invasion
Immunsuppressive treatment in transplant patients might have a negative effect on disease biology and may result in more disseminated disease and atypical sites of metastases as in our case

Summary

Discussion

Gastric metastases are quite rare and most common primary tumors are breast, melanoma and gastrointestinal carcinomas in western countries [4]. Ong et al reported a patient with renal metastasis of HCC [8] and Azarpira et al reported a case of skull metastasis of HCC, both being after liver transplantation and under immunsupressive treatment [9] In another case report, it was mentioned that renal transplant recipients with multiple cutaneous squamous cell cancers tended to have an aggressive disease course with multiple metastases resulting in death [10]. It was mentioned that renal transplant recipients with multiple cutaneous squamous cell cancers tended to have an aggressive disease course with multiple metastases resulting in death [10] This hypothesis might be tested in large retrospective series. In patients with rising AFP in the absence of progressive disease in liver and other sites in CT scans, gastrointestinal system metastases via hematogenous route should be kept in mind and upper endoscopy should be considered even in the absence of gastric symptoms, if the presence of extrahepatic disease will change treatment decisions

Introduction

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