Gastrointestinal metastasis in hepatocellular carcinoma: Radiological and endoscopic studies of 11 cases

Background: From October 1990 to January 1999, 11 of 2237 hepatoma patients at our hospital had gastrointestinal tract metastasis. We describe the rad iological and endoscopic features, clinical course and prognoses of those p atients. Methods: All patients were male. Six patients were hepatitis B carriers, an d cirrhosis was noted in eight patients on admission. We reviewed all avail able radiological, endoscopic and pathological features. Results: The commonest clinical presentation was frank gastrointestinal ble eding. Histological proof of gastrointestinal involvement was seen in six p atients. Endoscopic features included ulcerative tumours mimicking advanced gastric carcinoma (43%) and submucosal rumours (29%). The sites of organ i nvolvement were stomach (five), duodenum (two), colon (three) and duodenum and colon (one). Direct invasion by a contiguous neoplasm was the major rou te of gastrointestinal tract metastasis. Portal Min thrombosis may be the k ey point of haematogenous spread to other sites. Conclusions: The prognosis in these patients was extremely poor. Almost all patients died within 5 months if no further aggressive management was perf ormed. Surgical intervention may be the optimal choice for palliative treat ment of HCC with gastrointestinal tract involvement. (C) 2000 Blackwell Sci ence Asia Pty Ltd.