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      A Rare Colonic Metastasis Case from Hepatocellular Carcinoma

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          Abstract

          BACKGROUND:

          Hepatocellularcarcinoma (HCC) metastasis include intrahepatic and extrahepatic metastasis. Similar to intrahepatic metastasis, extrahepatic metastases are not unusual in cases with HCC. However, colonic metastasis is infrequent.

          CASE REPORT:

          We describe a clinical case, he was diagnosed with HCC a year ago, treated with TACE (transarterialchemoembolisation), re-examined with abdominal pain and defecation disorder. The tests such as CT scan, colorectal endoscopy, fine needle aspiration (FNA) revealed secondary metastatic lesion of HCC in sigmoid colon. This is the first gastrointestinal (GI) tract metastatic we have encountered.

          CONCLUSION:

          HCC metastases of the colon are rare, especially cases of hematogenous spread. The prognosis of these patients is often very critical. Indications for surgical removal of the lesion may be used if the general situation of patient is acceptable.

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          Most cited references15

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          Clinical features of hepatocellular carcinoma with extrahepatic metastases.

          Toshihiro Suga, Yoshiyasu Karino, Jouji Toyota … (2005)
          There are few detailed clinical reports about extrahepatic metastases of hepatocellular carcinoma (HCC). The purpose of the present study was to elucidate the clinical features of extrahepatic metastases of HCC. The clinical records of 482 patients who had been diagnosed as having HCC during the period from January 1995 to March 2001 were retrospectively reviewed. Extrahepatic metastases had been detected in 65 patients. Clinical features of those 65 patients were analyzed. Patients with extrahepatic metastases had more advanced intrahepatic tumors at the first diagnosis of HCC: 73.8% of the patients with extrahepatic metastases had tumors of intrahepatic tumor stage T3 or T4 according to the TNM classification, while only 28.5% of the patients without extrahepatic metastases had tumors of T3 or T4 (P < 0.001). Vessel invasion was also detected at the first diagnosis of HCC more frequently in the patients with extrahepatic metastasis (P < 0.001). The frequent metastatic sites were lung (53.8%), bone (38.5%), and lymph node (33.8%). Other metastatic sites were the adrenal gland, peritoneum, skin, brain and muscle. The median survival time and 1-year survival rate were 7 months (range: 1-59 months) and 24.9%, respectively. Patients with Child-Pugh grade B and C (P = 0.0018) and patients with positive serum alpha-fetoprotein (P = 0.011) had significantly poor prognosis. Extrahepatic metastases of HCC are not rare. The possibility of extrahepatic metastases and the clinical features of extrahepatic metastases should be considered when examining patients with HCC, particularly those with advanced intrahepatic tumors, to enable precise evaluation of the spread of HCC and determination of the appropriate treatment method. (c) 2005 Blackwell Publishing Asia Pty Ltd.
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            Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma.

            A Hiramatsu, Kazuaki Chayama, Hiroshi Aikata … (2007)
            To assess the clinical features and prognosis of 151 patients with extrahepatic metastases from primary hepatocellular carcinoma (HCC), and describe the treatment strategy for such patients. After the diagnosis of HCC, all 995 consecutive HCC patients were followed up at regular intervals and 151 (15.2%) patients were found to have extrahepatic metastases at the initial diagnosis of primary HCC or developed such tumors during the follow-up period. We assessed their clinical features, prognosis, and treatment strategies. The most frequent site of extrahepatic metastases was the lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). The cumulative survival rates after the initial diagnosis of extrahepatic metastases at 6, 12, 24, and 36 mo were 44.1%, 21.7%, 14.2%, 7.1%, respectively. The median survival time was 4.9 mo (range, 0-37 mo). Fourteen patients (11%) died of extrahepatic HCC, others died of primary HCC or liver failure. The prognosis of HCC patients with extrahepatic metastases is poor. With regard to the cause of death, many patients would die of intrahepatic HCC and few of extrahepatic metastases. Although most of HCC patients with extrahepatic metastases should undergo treatment for the primary HCC mainly, treatment of extrahepatic metastases in selected HCC patients who have good hepatic reserve, intrahepatic tumor stage (T0-T2), and are free of portal venous invasion may improve survival.
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              Population attributable fractions of risk factors for hepatocellular carcinoma in the United States.

              Oxana Makarova-Rusher, Sean F. Altekruse, Tim S McNeel … (2016)
              Hepatocellular carcinoma (HCC) incidence has been increasing in the United States for several decades; and, as the incidence of hepatitis C virus (HCV) infection declines and the prevalence of metabolic disorders rises, the proportion of HCC attributable to various risk factors may be changing.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Access Maced J Med Sci
                Journal ID (iso-abbrev): Open Access Maced J Med Sci
                Title: Open Access Macedonian Journal of Medical Sciences
                Publisher: Republic of Macedonia (ID Design 2012/DOOEL Skopje )
                ISSN (Electronic): 1857-9655
                Publication date Collection: 30 December 2019
                Publication date (Electronic): 20 December 2019
                Volume: 7
                Issue: 24
                Pages: 4368-4371
                Affiliations
                [1 ]Vietnam National Cancer Hospital, Hanoi, Vietnam
                [2 ]Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
                [3 ]Vietnam Military Medical University (VMMU), Hanoi, Vietnam
                Author notes
                [* ] Correspondence: Nguyen Duy Bac. Vietnam Military Medical University (VMMU), Hanoi, Vietnam. E-mail: nguyenduybac@ 123456vmmu.edu.vn
                Article
                Publisher ID: OAMJMS-7-4368
                DOI: 10.3889/oamjms.2019.837
                PMC ID: 7084010
                PubMed ID: 32215096
                SO-VID: f5c70493-a101-4c39-bebb-121afcd0c19b
                Copyright © Copyright: © 2019 Binh Van Pham, Huynh Huu Phan, Lam Le Ngo, Hang Thi Thuy Nguyen, Ky Van Le, Thien Chu Dinh, Nguyen Duy Bac.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0)

                History
                Date received : 11 September 2019
                Date revision received : 20 November 2019
                Date accepted : 21 November 2019
                Categories
                Subject: Basic and Clinical Medical Researches in Vietnam

                Keywords: hepatocelluar carcinoma,gi metastasis,sigmoid metastasis
                Data availability:
                Keywords: hepatocelluar carcinoma, gi metastasis, sigmoid metastasis

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