S2469 A Rare Case of Hepatocellular Carcinoma With Isolated Recurrence to the Stomach

Abstract

INTRODUCTION: Hepatocellular carcinoma (HCC) is the sixth-most common cancer worldwide and fourth leading cause of cancer-related mortality according to the WHO. It primarily metastasizes to the lungs, lymph nodes, and bones. Metastases of HCC to the gastrointestinal (GI) tract and specifically to the stomach are very infrequent. In this report, we present a unique case of HCC metastatic to the stomach. CASE DESCRIPTION/METHODS: A 61-year-old African-American (AA) female with hepatitis C-related cirrhosis complicated by HCC, originally diagnosed in 2015 and managed by partial hepatic resection. In April 2020, she underwent routine HCC surveillance imaging. MRI abdomen and pelvis (Figure 1) demonstrated no new liver lesions but was significant for an isolated 3.4 × 2.7 cm mass that was identified at the greater curvature of the stomach. She underwent upper endoscopy with endoscopic ultrasound revealing a 3.1 × 2.9 cm hypoechoic mass (Figure 2). Fine needle aspiration biopsy was performed, and pathology demonstrated an epithelioid mass compatible with HCC. Immunohistochemistry staining was positive for Cam5.2, glypican-3, and hepatocyte (partial) positive, confirming metastatic HCC. CT chest was negative for intrathoracic metastasis. The patient underwent partial gastrectomy in May 2020 given the isolated metastatic gastric lesion. Surgical pathology confirmed the diagnosis of moderately-differentiated metastatic HCC. DISCUSSION: We report a very rare case of metastatic HCC in an asymptomatic AA female, diagnosed on routine surveillance imaging for HCC. To our knowledge, this is the first reported case of HCC metastatic to the stomach in an African-American. Cases of HCC metastatic to the GI tract are exceedingly rare. The majority of cases of HCC with metastatic lesions in the stomach occur by direct extension rather than by hematologic dissemination. In documented cases, patients have presented most frequently with either iron deficiency anemia or abdominal pain. Almost all the reported cases have occurred in non-white individuals, and most have occurred in patients of East Asian ethnicities.Figure 1.: Greater curvature gastric mass.Figure 2.: EUS image of gastric mass.