Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3534-3541
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3534
Concurrent hepatocellular carcinoma metastasis to stomach, colon, and brain: A case report
Ryounggo Kim, Jooyweon Song, Sang Bum Kim
Ryounggo Kim, Department of Surgery, Dongnam Institute of Radiological & Medical Sciences, Busan 46033, South Korea
Jooyweon Song, Department of Pathology, Dongnam Institute of Radiological & Medical Sciences, Busan 46033, South Korea
Sang Bum Kim, Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul 01812, South Korea
Author contributions: Kim R was the patient’s surgeon, reviewed the literature, and contributed to manuscript drafting; Song J performed the pathological analyses and interpretation; Kim SB was responsible for the revision of the manuscript and for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: The patient has provided written informed consent for the publication of data and images.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors provided CARE checklist 2016.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ryounggo Kim, MA, MD, Chief Doctor, Department of Surgery, Dongnam Institute of Radiological & Medical Sciences, 40, Jwadong-gil, Jangan-eup, Gijang-gun, Busan 46033, South Korea. stumm@dirams.re.kr
Received: April 24, 2020
Peer-review started: April 24, 2020
First decision: May 15, 2020
Revised: June 8, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: August 26, 2020
Processing time: 123 Days and 3.4 Hours
Abstract
BACKGROUND

Extrahepatic metastasis (EHM) from hepatocellular carcinoma (HCC) occurs in 10%–15% of cases following initial treatment. The most frequent sites of EHM are the lung, lymph nodes, and bone. Gastrointestinal or brain metastasis from HCC is rarely reported. Here, we report a rare case of concurrent HCC metastases to the stomach, colon, and brain.

CASE SUMMARY

A 72-year-old male with a history of alcohol induced HCC presented with multiple intrahepatic recurrences and tumorous lesions in the stomach and ascending colon. Three years earlier, he underwent right hemihepatectomy, and 1 year ago, he had a video-assisted thoracoscopic wedge resection for pulmonary metastasis of HCC. We decided on surgical resection of the new metastases because of massive gastric bleeding and concern for possible colonic obstruction. The patient underwent gastric wedge resection and right hemicolectomy. Two weeks later, the patient developed dysarthria and mild cognitive disorder. Magnetic resonance imaging of the brain revealed a left frontal lobe lesion, and he underwent resection of a metastatic brain tumor. Unfortunately, he died 6 weeks after the last surgery due to hepatorenal syndrome.

CONCLUSION

Decision of surgery was carefully recommended in this case and may extend survival in other metastatic HCC patients with well-preserved hepatic function.

Keywords: Hepatocellular carcinoma; Extrahepatic metastasis; Stomach; Colon; Brain; Case report

Core tip: This was a very unusual case of concurrent stomach, colon, and brain metastasis of hepatocellular carcinoma. Extrahepatic metastasis of hepatocellular carcinoma has a poor prognosis. However, deteriorated hepatic function due to intrahepatic metastases is more often the cause of death than is extrahepatic metastasis. Treatment of extrahepatic metastases is still suggested to control tumor progression. Surgical resection of these metastases may extend survival and quality of life and should be considered in patients with well-preserved hepatic function.