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UCTN ± Unusual cases and technical notes E257

Metastatic hepatocellular of the : an unusual cause of upper gastro− intestinal bleeding

Fig. 2 a Photomicro− graph showing nests of tumor cells in a trabec− ular arrangement in the subepithelial region (H&E, original magnifi− cation ” 100). b Photomicrograph showing brown cyto− plasmic staining, indi− cating that the tumor cells are positive for monoclonal antibody paraffin 1 (original magnification ” 100).

Fig. 1 a Endoscopic view showing small esophageal varices without red marks and one polypoid lesion near the esophagogastric junction. b Closer endoscopic view showing surface oozing of the polypoid lesion.

Hepatocellular carcinoma (HCC) is a hy− pervascular tumor that frequently metas− tasizes through systemic vessels or the A 53−year−old man presented at our insti− showed small esophageal varices without portal system. Lung, adrenal and tution with a 1−day history of . His red marks, and a 0.6−cm polypoid lesion bone are the common sites of distant me− past medical history was notable for he− with an oozing surface near the esopha− tastasis of HCC [1]. On the other hand, the patitis−B−related and hepatocel− gogastric junction (l" Fig. 1). No ulcer or incidence of metas− lular carcinoma. Physical examination re− any other bleeding focus was found in This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. tasis of HCC is typically low, with the vealed anemia, and a slightly the stomach or . We concluded stomach, duodenum and colon being the distended abdomen with . Labora− that the polypoid lesion had bled and most commonly involved organs [2]. tory data included a hematocrit of 22.9% caused melena. specimens were Esophageal is especially rare (normal 42%±52%), a mean corpuscular taken and argon plasma coagulation was in patients with HCC [1]. The major volume of 100/fl (normal 80±94/fl), a to− performed for hemostasis. The histo− symptoms of metastatic HCC of the tal bilirubin level of 4.9 mg/dl (normal pathological assessment of the biopsy esophagus include dysphagia and gastro− 0.2 ±1.2 mg/dl), and an albumin level of specimens demonstrated nests of tumors intestinal bleeding [3±5]. Endoscopically, 2.2 g/dl (normal 3.8±5.3 g/dl). Prothrom− cells in a trabecular arrangement in the metastatic HCC of the esophagus may bin time was 16.4 s (normal 10±14 s) and subepithelial region (l" Fig. 2 a). Immu− present as a submucosal tumor or a poly− a−fetoprotein was 17036 ng/ml (normal nohistochemical staining revealed posi− poid mass [3±5]. We report here a case of < 13.4 ng/ml). Previous computed tomog− tivity for monoclonal antibody hepato− metastatic HCC of the esophagus, which raphy of the abdomen demonstrated a cyte paraffin 1 (Hep Par 1), confirming presented as an oozing polypoid lesion at spreading−type HCC in the left lobe of the liver as the primary origin of metasta− upper gastrointestinal endoscopy. liver with portal vein tumor thrombi. Ur− sis (l" Fig. 2 b). A diagnosis of metastatic gent upper gastrointestinal endoscopy HCC was made. The patient died of pro−

Yan S−L et al. Metastatic hepatocellular carcinoma of the esophagus¼ Endoscopy 2007; 39: E257±E258 E258 UCTN ± Unusual cases and technical notes

gressive hepatic failure 1 month later, and References Bibliography was not permitted. 1 Nakashima T, Okuda K, Kojiro M et al. Pathol− DOI 10.1055/s−2007−966480 ogy of hepatocellular carcinoma in Japan. Endoscopy 2007; 39: 257±258 232 Consecutive cases autopsied in ten  Georg Thieme Verlag KG Stuttgart ´ New York ´ Endoscopy_UCTN_Code_CCL_1AB_2AC_3AB years. 1983; 51: 863± 877 ISSN 0013−726X 2 Chen LT, Chen CY, Jan CM et al. Gastrointesti− S.−L. Yan, Y.−H. Hung, T.−H. Yang nal tract involvement in hepatocellular car− Corresponding author cinoma: clinical, radiological and endo− Division of Gastroenterology, Department Y.−H.Hung, MD scopic studies. Endoscopy 1990; 22: 118± of Internal Medicine, Chang Bing Show− Division of Gastroenterology, 123 Chwan Memorial Hospital, Taiwan, Repub− 3 Kume K, Murata I, Yoshikawa I et al. Polypoid Department of Internal Medicine lic of metastatic hepatocellular carcinoma of the Chang Bing Show−Chwan Memorial Hospital esophagus occurring after endoscopic vari− No. 6, Lugong Road ceal band ligation. Endoscopy 2000; 32: Lugang Township 419 ± 421 Changhua County 505 4 Sohara N, Takagi H, Yamada T et al. Esopha− Taiwan, Republic of China geal metastasis of hepatocellular carcino− Fax: +886±4−7233190 ma. Gastrointest Endosc 2000; 51: 739 ±741 [email protected] 5 Cho A, Ryu M, Yoshinaga Y et al. Hepatocellu− lar carcinoma with unusual metastasis to the esophagus. Hepatogastroenterology 2003; 50: 1143 ± 1145 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Yan S−L et al. Metastatic hepatocellular carcinoma of the esophagus¼ Endoscopy 2007; 39: E257 ±E258