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Hepatocellular Carcinoma Invading the Stomach with Hemorrhage: A Case Report and Review of the Literature
並列摘要
Hepatocellular carcinoma (HCC) metastases directly to the stomach mimicking a chronic ulcer or advanced gastric cancer with hemorrhage is relatively unusual. A 70-year-old male complained of right upper quadrant pain, massive melena episodes and hematemesis for two days. The gastroendoscopy yielded a submucosa mass with ulcerative mucosa and active bleeding. The abdominal sonography and computed tomography (CT) images of the liver revealed an ill-circumscribed solitary hepatic mass over the segment 2 and 3 areas of the left lobe. He underwent an exploratory laparotomy because the bleeding could not be controlled. Primary advanced cancer of the antrum of the stomach with liver metastasis was highly suspected. The pathological characteristics and immunohistochemical stains demonstrated that primary HCC had expansively invaded the gastric serosa and submucosa, resulting exposure in the mucosa. This extremely rare case involved primary HCC directly invading the stomach and clinically presenting as a chronic ulcer or advanced cancer with active bleeding. We, herein, report on a case with the ubiquitous clinical manifestations of non-variceal bleeding, urosepesis with septic shock six months after surgical intervention, and a review of the relevant literature.