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Hepatocellular carcinoma complicated by gastrointestinal hemorrhage caused by direct tumor invasion of stomach
Author(s) -
Maruyama Akira,
Murabayashi Koji,
Hayashi Masanobu,
Nakano Hideaki,
Isaji Shuji,
Uehara Shinichi,
Kusuda Tsukasa,
Miyahara Shigeki,
Kondo Akinobu,
Nakano Hiroshi,
Yabana Tadashi
Publication year - 1999
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s005340050089
Subject(s) - medicine , hepatocellular carcinoma , melena , curvatures of the stomach , stomach , lumen (anatomy) , embolization , radiation therapy , arterial embolization , gastrointestinal bleeding , gastrectomy , carcinoma , gastroenterology , radiology , cancer
A 65‐year‐old man with multiple hepatocellular carcinoma (HCC) underwent intra‐hepato‐arterial chemotherapy (IHAC) through an implantable port over a period of 10 months after transcatheter arterial embolization (TAE) had been performed three times. TAE was performed twice more, and radiotherapy (total dose, 30 Gy; given over a 3‐week period) was given for progressive disease in the lateral segment of the liver. Three months after the radiotherapy had finished, the patient suddenly developed melena. Diagnostic imaging revealed gastrointestinal (GI) hemorrhage from HCC invading the stomach, and total gastrectomy and lateral segmentectomy of the liver were performed because the bleeding could not be controlled. The resected specimen disclosed a centrally necrotic tumor that had invaded the lesser gastric curvature and perforated into the lumen. Pathology examination revealed that the HCC had expansively invaded the gastric mucosa, resulting in exposure in the lumen. The possible mechanisms of direct GI invasion by HCC are briefly discussed, with a review of the literature. GI bleeding secondary to involvement by HCC is rare. The enteric radiation injury seems to have been largely resposible for the GI bleeding in this patient.