Introduction

Hepatocellular carcinoma (HCC), commonly linked to chronic liver disease like alcoholic liver disease (ALD), remains a leading cause of cancer-related deaths due to recurrence and metastasis. While HCC frequently spreads to distant organs, gastrointestinal involvement is rare, seen in only 0.2–2% of cases, often presenting as gastrointestinal bleeding. This case report describes a 65-year-old man with ALD and previously treated HCC, who presented with upper gastrointestinal bleeding and was found to have HCC directly invading the stomach.

Case report

We report the case of a 65-year-old man with a medical history of alcoholic liver disease (ALD) and a previous Barcelona stage B hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE) therapy three years prior and no follow-up. He arrived at the Emergency Department (ED), complaining of abdominal pain, weight loss, melena, and hematemesis. The physical examination revealed a mass in the right hypochondrium. The upper endoscopy revealed an extraintestinal mass infiltrating the lesser curvature (Fig. 1). We took eight lesion biopsies for pathological analysis, reporting metastatic HCC (CK-OSCAR +, CK19+, Arginase + PEARLS -). An enhanced abdominal Computed Tomography scan (CT scan) revealed HCC infiltration of the stomach (Fig. 1). The patient decided to ask for a voluntary discharge and lost follow-up.

Figure 1 A: upper endoscopy. Indurated extraintestinal mass invading the lesser curvature of the stomach extending through the infiltrating site up to the antrum. B: endoscopic view in retroflexion. C: CT scan axial view revealed a multinodular lesion in the hepatic segments II, III, and IV with measurements of 17 x 16 x 14.5 cm and a volume of 2050 mL. D: coronal section showing tumor invading the stomach. E: sagittal section with displacement of intestinal structures. 

Discussion

Up to 0.2 - 2 % of HCC cases involve the gastrointestinal tract, and the stomach and duodenum represent the most common metastatic site. The most common presentation is gastrointestinal bleeding¹. There are previous reports of direct invasion of HCC to the stomach²,³. Left hepatectomy with distal gastrectomy and systemic treatment seem to represent viable options for this case.