A Case of Hepatocellular Carcinoma with Colonic Metastasis

Abstract

We report a rare case of hematogenous colonic metastasis from hepatocellular carcinoma (HCC) which followed multidisciplinary therapy for recurrent HCC and was successfully resected. A 65-year-old man underwent lateral sectionectomy for HCC. Ten months later, a recurrent HCC in the segment 4 and recurrent disseminated nodules (DN) were diagnosed. Intrahepatic recurrence was treated with radiofrequency ablation, and the DN were surgically extirpated. Nineteen months after the initial surgery, another DN was found again, and the patient underwent re-resection. During adjuvant chemotherapy with lenvatinib, a new DN was detected, and the anticancer drug was changed to sorafenib, which kept the DN reduced in size for one year and two months. Then the CA19-9 level became elevated and colonoscopy revealed a sigmoid colon tumor, which was pathologically diagnosed to be a metastatic HCC. Laparoscopic sigmoidectomy and resection of the DN were carried out. Intraoperative inspection and histopathological findings revealed that the sites of colonic tumor and the DN were distant and the colonic tumor did not invade the serosa of the colon. We finally diagnosed it as hematogenous colonic metastasis of HCC. The patient is alive without recurrence in 8 months after the last operation.