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- Title
Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway.
- Authors
Ming-Luen Hu; Wei-Chen Tai; Seng-Kee Chuah; Yi-Chun Chiu; Keng-Liang Wu; Yeh-Pin Chou; Chung-Mou Kuo; Tsung-Hui Hu; King-Wah Chiu
- Abstract
Background and Aim: Hepatocellular carcinoma (HCC) tends to metastasize to extrahepatic organs. Stomach involvement has been seldom reported and has always been considered as direct invasion. This study aims to propose a possible existing pathway for the hematogenous metastasis of HCC to the stomach. Methods: Only seven cases with stomach involvement were found from 8267 HCC patients registered at our hospital between 2000 and 2007. Their laboratory data, the findings of computed tomography and upper endoscopy, therapeutic procedures, such as esophageal variceal banding ligation (EVL), and transhepatic arterial embolization (TAE) were further studied. Results: All seven patients were male. Liver cirrhosis was found in six patients (6/7 = 85.7%), HCC with portal vein thrombosis (PVT) in six patients (6/7 = 85.7%), splenomegaly in five patients (5/7 = 71.4%) and esophageal varices in five patients (5/7 = 71.4%). Six patients underwent TAE and one patient underwent EVL before the development of HCC in the stomach. Four patients had HCC at the cardia, one patient at the anterior wall of the high body and two patients at the greater curvature of the high body, far away from the original HCC. Six patients eventually developed distant metastasis. HCC with gastric metastasis developed 53–126 days after TAE in five patients and 74 days after EVL in one patient. Conclusions: When cirrhotic patients with portal hypertension have HCC with PVT, a hematogenous pathway can exist for gastric metastasis of tumor thrombi involving hepatofugal flow to the stomach after TAE or EVL apart from the major pathway of direct invasion.
- Subjects
LIVER cancer; METASTASIS; ESOPHAGEAL varices; ENDOSCOPY; ESOPHAGUS diseases; THERAPEUTIC embolization
- Publication
Journal of Gastroenterology & Hepatology, 2010, Vol 25, Issue 2, p408
- ISSN
0815-9319
- Publication type
Article
- DOI
10.1111/j.1440-1746.2009.06022.x