Abstract
BackgroundColonic metastasis is uncommon in patients with hepatocellular carcinoma (HCC). In the past, extrahepatic metastasis of HCC was not treated aggressively because of its poor prognosis. Herein, we describe the case of a patient with HCC who survived for 30 months following resection of a metastatic tumor in the ascending colon.Case presentationAn 80-year-old man presented at our hospital with symptoms of abdominal pain on the right side and fever. He had undergone transcatheter arterial chemoembolization and posterior segment resection of the liver because of HCC, followed by radiofrequency ablation for a recurrent intrahepatic lesion 5 and 3 years, respectively, prior to the visit. He was diagnosed with retroperitoneal hematoma, which was thought to be associated with diverticulitis and an extramural tumor in the ascending colon. A definitive diagnosis could not be reached; however, a right hemicolectomy of the colon was performed because of progression to anemia. A pathological examination revealed a metastatic tumor in the ascending colon extending from the subserosal layer to the muscularis propria layer. The patient was treated with lenvatinib after surgery, but presented with intrahepatic recurrence, lymph node metastasis, and peritoneal dissemination metastasis 15 months later. The progression of the disease could not be controlled and his postoperative survival time was 30 months.ConclusionResection of metastasis of HCC might contribute to prolonged survival in cases, where radical resection is possible.
Highlights
Colonic metastasis is uncommon in patients with hepatocellular carcinoma (HCC)
Colonic metastasis is an uncommon occurrence in hepatocellular carcinoma (HCC)
Extrahepatic metastasis of HCC was not treated aggressively because of its poor prognosis; recent studies indicate that surgery can improve the prognosis if the metastatic lesion is completely resected [1,2,3]
Summary
Colonic metastasis is an uncommon occurrence in hepatocellular carcinoma (HCC). In the past, extrahepatic metastasis of HCC was not treated aggressively because of its poor prognosis; recent studies indicate that surgery can improve the prognosis if the metastatic lesion is completely resected [1,2,3]. The patient had been followed up at our hospital for chronic hepatitis C He had undergone transcatheter arterial chemoembolization (TACE) and posterior segment resection of the liver for HCC (S6; Couinaud’s hepatic segment) 5 years before this visit and radiofrequency ablation (RFA) for intrahepatic recurrence (S8) 3 years ago. Pathological findings The patient was diagnosed with moderately differentiated HCC of the ascending colon, located mainly within the subserosal and muscular layers, where a continuous retroperitoneal hematoma was observed. This tumor was similar to the tumor resected 5 years ago and was. The same chemotherapy was continued thereafter, but the progression of the disease could not be controlled. 26 months after surgery, he was switched to palliative care and his postoperative survival time was 30 months
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