Case Of Metastatic Hepatocellular Carcinoma Research Articles

A Case of Metastatic Hepatocellular Carcinoma in Sphenoid Sinus with Intractable Nasal Bleeding Controlled by Radiation Therapy

We report a case of metastasis of hepatocellular carcinoma (HCC) into an isolated sphenoid sinus cavity presenting with intractable nasal bleeding. A 62-year-old man who diagnosed with HCC, visited our department with recurrent nasal bleeding for a month. Endoscopic examination and imaging demonstrated a homogeneous enhancing solid mass in the right sphenoid sinus. Although several anterior nasal packing was performed, epistaxis of oozing pattern persisted. Eventually, nasal bleeding was successfully controlled after palliative radiation therapy.

S1792 Metastatic Hepatocellular Carcinoma Diagnosed on Post-Diverticulitis Colonoscopy

Introduction: Acute diverticulitis occurs in 10-20% of patients with diverticulosis. In patients with acute diverticulitis, guidelines recommend performing a colonoscopy 6-8 weeks after resolution of symptoms to rule out an underlying colonic malignancy. Here we present a unique case of metastatic hepatocellular carcinoma (HCC) masquerading as acute diverticulitis in a patient with a history of HCC that has been in remission. Case Description/Methods: A 71-year-old man presented to the emergency room with a 1-week history of generalized abdominal pain and fatigue. Past medical history includes orthotropic liver transplantation in 2014 for hepatitis C cirrhosis and HCC. He has good hepatic function and HCC has been in remission. In the emergency room, vital signs were within normal limits. Complete blood count and comprehensive metabolic panel were unremarkable. Abdominal computed tomography with intravenous contrast revealed acute diverticulitis of the descending colon with a 1.4 cm intramural abscess and 1.1 cm abscess adjacent to the colon. This is new compared to abdominal cross-sectional imaging obtained 10 days before. The liver was reportedly normal without any lesion. He was hospitalized and managed conservatively with bowel rest and intravenous antibiotics. He was discharged a few days later after resolution of his symptoms. Two months later, he underwent a colonoscopy showing a small area of irregular mucosa in the descending colon that was concerning for a possible infiltrative lesion (Figure 1). Biopsies of this area revealed metastatic HCC. There was no evidence of diverticulosis on this exam. Discussion: Guidelines recommend that patients with an episode of acute diverticulitis should undergo colonoscopy 6—8 weeks after the resolution of symptoms to exclude colon cancer. Our patient was surprisingly found to have metastatic deposits of hepatocellular carcinoma despite being in remission. In patients with history of extracolonic malignancies, metastatic deposits should be considered in the differential diagnosis of acute diverticulitis and colonoscopy should be performed after symptom resolution.Figure 1.: Colonoscopy showing a small area of irregular mucosa in the descending colon that was concerning for a possible infiltrative lesion, pathology ultimately consistent with hepatocellular carcinoma.

A Case of Hepatocellular Carcinoma Metastasis to the Dorsal Tongue

Hepatocellular carcinoma (HCC) is a common neoplasm, and its metastasis to the head and neck area is rare. We herein describe a unique case of HCC metastasis to the dorsal tongue. A 54-year-old male who was already diagnosed with HCC visited our hospital complaining of dysphagia and a progressively enlarging dorsal tongue mass. We operated to excise on the mass using CO2 laser including mucosal margin and deep margin. The diagnosis of HCC metastasis was confirmed immunohistochemically. After 2 weeks of follow-up, the patient did not exhibit any evidence of complication and could eat orally without any problem. Further treatment to the other metastatic lesion was rejected, and the patient was followed up for more than six months. We introduce this first case of metastatic HCC in the dorsal tongue. With the extended life expectancy of HCC patients, the incidence of rare metastasis is expected to increase. Key words: Dorsum of tongue ㆍ Hepatocellular carcinoma ㆍ Metastasis

Abstract #112: Planting Seeds: A Case of Metastatic Hepatocellular Carcinoma to Bilateral Adrenal Glands

Abstract #112: Planting Seeds: A Case of Metastatic Hepatocellular Carcinoma to Bilateral Adrenal Glands

A Case of Metastatic Hepatocellular Carcinoma to the Sphenoid Sinus Controlled by Transcatheter Arterial Embolization

A Case of Metastatic Hepatocellular Carcinoma to the Sphenoid Sinus Controlled by Transcatheter Arterial Embolization

A Case of Metastatic Hepatocellular Carcinoma of the Nasal Septum

A Case of Metastatic Hepatocellular Carcinoma of the Nasal Septum

動脈塞栓術が有効であった肝細胞癌蝶形骨洞転移例

動脈塞栓術が有効であった肝細胞癌蝶形骨洞転移例

Carcinoma hepatocelular metastático em Jaguatirica (Leopardus pardalis )

RESUMO: O carcinoma hepatocelular (CHC) é uma neoplasia rara nos animais domésticos e em espécies selvagens foi relatado somente em antílopes, veado, cães da pradaria e furões, mas não existem relatos em Leopardus pardalis (jaguatirica). Este trabalho descreve um caso de carcinoma hepatocelular metastático em uma fêmea felina de aproximadamente 18 anos de idade, da espécie Leopardus pardalis, proveniente do Parque Zoobotânico de Teresina-PI, com histórico de anorexia, apatia e evolução ao óbito que foi encaminhada ao Setor de Patologia Animal da Universidade Federal do Piauí para exame anatomopatológico. À necropsia foram observadas duas nodulações de aproximadamente 8,0cm de diâmetro no fígado, de coloração variando da brancacenta ao vermelhado claro, amarelada a vermelho escuro, subdivididas em lóbulos por tecido conjuntivo. No pâncreas foram observadas múltiplas nodulações de aproximadamente 1,0 cm de diâmetro, com superfície lisa, consistência firme, coloração vermelho-amarelada. A superfície de corte dos rins também apresentava várias nodulações milimétricas de distribuição multifocal, na região córtico-medular, consistência firme, coloração branco-acinzentada ou amarelada, sugerindo metástase. Os fragmentos das lesões de fígado foram coletados e no exame microscópico observaram-se proliferação de hepatócitos em cordões bem diferenciados, formando trabéculas com espessura de três ou mais células. Os hepatócitos apresentavam-se volumosos, pleomórficos, com citoplasma eosinofílico. Na coloração com PAS constataram-se, regularmente, acúmulo de glicogênio nos hepatócitos neoplásicos. A confirmação foi feita pela técnica de imunoistoquímica, utilizando-se anticorpo monoclonal (Hepatocyte Specific Antigen). Os achados anatomohistopatológicos, e o auxilio da imunoistoquímica permitiram concluir pelo diagnóstico de hepatocarcinoma trabecular metastático em Leopardus pardalis criado em cativeiro.

肝細胞癌胃転移の1例

症例は76歳，男性．2年前に肝S2の肝細胞癌に対し肝外側区域切除術を施行された．7カ月前からの食後の逆流症状を訴えたため，上部消化管内視鏡検査を施行した．胃前庭部に5mm大の隆起性病変を認め，生検ではgroup3，adenomaであった．4カ月後，腹部造影CT検査で胃前庭部の壁肥厚を認めた．内視鏡検査では胃前庭部の隆起性病変は増大していたが，粘膜は保たれているように見えた．生検では低悪性度の腫瘍と診断された．胃癌を疑い，2013年8月にリンパ節郭清を伴う幽門側胃切除術を施行した．病理組織学的検査で中分化型肝細胞癌の胃転移と診断された．胃切除後2年の現在，無再発生存中である．肝細胞癌胃転移のほとんどは超進行癌である．しかし，自験例のように門脈逆行性と考えられ，AFP値が低値の肝細胞癌胃転移では，胃切除で長期生存が期待できる症例も存在すると思われる．

鼻中隔に転移した肝細胞癌例

鼻中隔に転移した肝細胞癌例

Uptake of gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid in metastatic adrenal tumour from hepatocellular carcinoma

We present the case of a metastatic adrenal tumour from hepatocellular carcinoma (HCC) showing the uptake of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) on MRI. To our knowledge, this is the first case of metastatic HCC in which Gd-EOB-DTPA uptake was shown on MRI and this finding facilitated the accurate pre-operative diagnosis of a metastatic adrenal tumour.

A case of metastatic hepatocellular carcinoma with numb chin syndrome as the initial manifestation

A case of metastatic hepatocellular carcinoma with numb chin syndrome as the initial manifestation

Metastatic Hepatocellular Carcinoma to the Nasal Cavity: A Case Report and Review of the Literature

Hepatocellular carcinoma is a common primary hepatic malignancy in the Asian countries. The prognosis of metastatic hepatocellular carcinoma is very poor if left untreated. Despite the rare occurrence, sinonasal metastasis of hepatocellular carcinoma usually implies an advanced disease stage with dismal outcome. Herein we present a case of metastatic hepatocellular carcinoma involving the nasal cavity. This 55-year-old male patient refused standard therapy after the diagnosis of hepatocellular carcinoma. After a palliative excision for the nasal tumor, the patient died of multiple metastatic diseases. A special consideration should be given to such unusual manifestations of extrahepatic metastases. Promptly clinical evaluation and appropriate intervention for symptomatic palliation are necessary for these terminally ill patients.

Metastatic Hepatocellular Carcinoma in the Tympanic Membrane

Primary tympanic membrane cancer is very rare; metastatic cancer to the tympanic membrane is extremely rare and presents diagnostic challenges. We report a case of metastatic hepatocellular carcinoma in the tympanic membrane. The presenting symptom was hearing loss. Physical examination revealed a friable granulomatous mass over the left anterior tympanic membrane extended from the external auditory canal. Computed tomography scan of the temporal bone revealed one soft tissue mass involving the left external auditory canal and tympanic membrane. A left middle ear mass biopsy was performed. The tumor cells were uniformly positive for cytokeratin and hepatocyte paraffin-1, confirming a diagnosis of metastatic tympanic membrane. A tympanic membrane mass might easily be misdiagnosed and improperly treated. This case serves as a reminder that the differential diagnosis of acute hearing loss in cancer patients should include the metastasis occurring in the auditory canal or tympanic membrane, and that tissue biopsies are necessary to establish the definitive diagnosis for such lesions.

A Rare Case of Metastatic Hepatocellular Carcinoma to the Colon with Associated Paraneoplastic Syndrome

Purpose: Hepatocellular carcinoma (HCC) is an aggressive malignancy with poor prognosis that is associated with a 4-6 month mean survival. Early detection with surgical resection offers the best chance for long-term survival. There are rare cases of patients with extrahepatic HCC recurrences. We report an unusual case of extrahepatic HCC occurring 18 and 36 months following initial presentation. Results: A 79-year-old man presented with 1 month of persistent epigastric pain. An abdominal CT revealed a large (16.5 × 13.8 cm), lobulated mass in the left hepatic lobe. Hepatitis B and C serology were negative. An alpha feto-protein (AFP) was 123 ng/mL. A left hepatic lobectomy was performed. Pathology revealed a high grade hepatocellular carcinoma. Surveillance included serial AFPs (which had normalized) and regular CT scans. Sixteen months after hepatic resection, he had a gastric outlet obstruction. An abdominal CT revealed a large (8.4 × 8.1 cm) exophytic gastric mass. An AFP was 23 ng/mL. An EGD with EUS revealed a retrogastric mass with cystic components. FNA obtained necrotic tissue and tumor fragments consistent with metastatic HCC. A distal gastrectomy with roux gastrojejunostomy was performed. Pathology revealed a poorly differentiated carcinoma consistent with the primary HCC. He remained clinically stable for 18 months when an abdominal CT revealed a mid-transverse colon mass. A colonoscopy performed prior to the hepatic resection removed 5 diminutive tubular adenomas. A repeat colonoscopy revealed a partially obstructing, malignant appearing mass. Biopsies revealed a poorly differentiated carcinoma consistent with metastatic HCC. Additionally, biopsies of the nodular mucosa in the cecum revealed lamina propria, intraepithelial and muscularis mucosal eosinophils. The peripheral eosinophil count was 24%. A transverse colectomy with primary anastomosis was performed. The specimen was described as an eccentric fungating lesion involving the full thickness of the bowel with gross invasion of the pericolic fat. There were no other intra-abdominal masses or liver metastases. Conclusion: This is a rare case of extrahepatic HCC metastases occurring at 18 and 36 months following hepatic resection. Gastrointestinal involvement of HCC is highly unusual, occurring in 0.5-2% of cases. The most common site of GI involvement is the duodenum, followed by stomach and least often colon. The presumed mode of transmission is direct invasion of the GI tract. However, hematogenous spread to the colon has been speculated and is thought to have occurred in this patient. Awareness of the unusual occurrence of extrahepatic metastatic HCC is important to ensure adequate surveillance following primary resection.

A case of metastatic hepatocellular carcinoma of the rib, treated by transcatheter arterial chemoembolization

Bone is a common site of metastasis in patients with hepatocellular carcinoma (HCC). We report a rare case of rib metastasis from HCC treated by transcatheter arterial chemoembolization (TACE). A 55-year-old man with liver cirrhosis presented with right lower chest pain. The diagnosis was an HCC with a bone metastasis in the right eighth rib. Intra-arterial injections of doxorubicin mixed with Lipiodol and Gelfoam particles were instituted through the right eighth intercostal artery. Computed tomography and a Tc(99)-labeled scan performed 2 months after the third TACE revealed no viable HCC in the right eighth rib.

비출혈로 진단된 전이성 간세포암종 1예

A rare case of metastatic hepatocellular carcinoma (HCC) of the nasal cavity in a 54-year-old man is reported along with the findings at biopsy. Radiographic examination revealed masses in the liver and lung metastases. Histologically, proliferation of tumor cells with resemblance to HCC was observed. Extrahepatic metastasis of HCC is not infrequently found during the later stage. Hepatocellular carcinoma usually metastasizes to lung, breast, lymph node, GI tract, bone, kindey, and adrenal gland. However, metastasis to the nasal cavity and paranasal sinuses has been seldom reported in our knowledge. Epistaxis in patients with metastasis to the nasal cavity can be difficult to control by conventional method. Epistaxis was successfully treated by transcatheter arterial embolization. (J Clinical Otolaryngol 2008;19:218-222)

Metastatic hepatocellular carcinoma of the external auditory canal

This report describes a rare case of metastatic hepatocellular carcinoma (HCC) presenting a huge mass in the left external auditory canal (EAC). The patient was a 55-year-old man with hepatitis B virus-related HCC. He presented to our department with a three-month history of increasing left otalgia, and hearing loss with recent fresh aural bleeding. Histopathologic examination indicated that the tumor was secondary to HCC. Although external irradiation was not effective, the tumor was treated with surgical debulking and high dose rate 192 Ir remote afterloading system (RALS) for postoperative intracavitary irradiation. A review of the literature revealed only five other cases of HCC metastasis to the temporal bone, all of which mainly metastasized in the internal acoustic meatus. The present case is the first report of HCC metastasis to the EAC.

Study of expression of CD138 and heparinase in hepatocellular carcinoma by tissue microarray

To study the expression of CD138 and heparinase in hepatocellular carcinoma (HCC) and its relationship with tumor development, progression, metastasis and recurrence. Tissue microarray and immunohistochemical study (EnVision method) for CD138 and heparinase was performed on tissue microarray which consisted of 197 cases of HCC, including adjacent non-neoplastic liver tissues, and 66 cases of HCC metastases. The rates of CD138 expression in HCC and adjacent non-neoplastic liver tissues were 48.7% (96/197) and 65.0% (128/197, P < 0.05) respectively. In early-stage and late-stage tumors, the expression rates were 61.7% (29/47) and 44.7% (67/150, P < 0.05) respectively. The rate in patients with metastasis was 33.3% (22/66), as compared with 53.6% (45/84, P < 0.05) in patients without metastasis. In patients with tumor recurrence occurring within or after 1 post-operative year, the expression rates were 23.3% (7/30) and 61.1% (11/18, P < 0.05) respectively. On the other hand, the rates of expression of heparinase in HCC and adjacent non-neoplastic liver tissues were 35.5% (70/197) and 12.7% (25/197, P < 0.05) respectively. In early-stage and late-stage tumors, the expression rates were 29.8% (14/47) and 37.3% (56/150, P > 0.05) respectively. The rate in patients with metastasis was 48.5% (32/66), as compared with 28.6% (24/84, P < 0.05) in patients without metastasis. In patients with tumor recurrence occurring within or after 1 post-operative year, the expression rates were 50.0% (15/30) and 44.4% (8/18, P > 0.05) respectively. In the 66 cases of metastatic HCC studied, the expression rate of CD138 was lower in the heparinase-positive subgroup (P < 0.05). Loss of CD138 expression is related to HCC development, progression, metastasis and recurrence. Overexpression of heparinase, when coupled with loss of CD138 expression, may take part in tumor metastasis of HCC.

A case of metastatic hepatocellular carcinoma in the nasal cavity

Metastatic hepatocellular carcinoma in the nasal cavity and paranasal sinuses is rare. We report the case of a 71-year-old male afflicted with hepatocellular carcinoma with metastasis in the maxillary sinus and nasal cavity. He underwent radiation therapy with a total dose of 36 Gy, but he died of terminal liver failure. The possible metastatic route and prognosis of metastatic hepatocellular carcinoma in the sinonasal tract are discussed.