Abstract
A 48-year old male was admitted because of melena and increasing ascites. He recently had surgical procedures for esophageal varices under the diagnosis of liver cirrhosis. Laboratory studies suggested the presence of hepatoma. Endoscopic examination showed a picture like that of multiple submucosal tumors at the second portion of the duodenum. Postmortem examination disclosed hepatocellular carcinoma associated with cirrhosis and its metastasis to the duodenum causing such endoscopic appearance. Tumor thrombi were seen only in the portal vein and its branches, pancreas and duodenum. There was no metastasis in other organs including the lungs or lymph nodes surrounding the portal vein. So on this case, it seems reasonable to conclude that the duodenal metastasis was brought by retrograde tumor thrombi through the portal vein system. To our knowledge, this is the first report of hepatoma with metastasis to the duodenum causing polypoid lesions by retrograde tumor thrombi.
