S4424 An Unusual Report of Gastric Metastasis in Hepatocellular Carcinoma with Review of Literature
Notice bibliographique
Résumé
Introduction: Hepatocellular carcinoma (HCC) is a primary neoplasm of the liver that develops in a setting of chronic liver disease and cirrhosis. Metastasis in the stomach is extremely rare. We present a case of HCC, secondary to metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis, with an incidental finding of gastric metastasis during variceal surveillance. Case Description/Methods: A 72-year-old man presented to the Emergency Department with acute onset abdominal pain. His medical history was notable for stroke, type-2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea and obesity. Initial laboratory investigations showed normal levels of leukocytes and platelets and a hemoglobin level of 104 g/L (126-180 g/L). His liver enzyme panel was unremarkable, except for an elevated γ-glutamyl transferase level of 1.82 ukat/L (0.07-1 ukat/L). The liver function tests were normal. Computed tomography (CT) of the chest, abdomen, and pelvis illustrated cirrhosis and 2 arterial hyper-enhancing liver lesions compatible with multifocal HCC. Alpha-fetoprotein and carbohydrate antigen 19-9 levels were within normal limits. A liver biopsy revealed a well-differentiated HCC. Subsequently, trans-arterial chemoembolization was performed. Chronic liver disease workup was negative, and diagnosis of MASH compensated cirrhosis was made, with Child-Pugh A classification. Chemotherapy was initiated. Within 3 months of diagnosis, metastatic lesions in the adrenal gland and vertebral bodies were observed. Surveillance esophagogastroduodenoscopy (EGD) for varices showed portal hypertensive gastropathy with no varices. However, 2 gastric polyps were identified: 1 cm within the antrum and a pedunculated 2 × 3 cm polyp with an irregular border and pitting at the fundus. The larger polyp was removed. Pathological examination of the fundus polyp revealed metastatic HCC; no new symptom was reported from the patient. At a 2-year follow-up period, cirrhosis remains compensated. His metastatic HCC extends to the splenic and pelvic osseous structures. The patient remains on chemotherapy. Discussion: This case highlights the possibility of gastric metastasis in a patient with advanced HCC. The nonspecific presentation of gastric metastasis makes the diagnosis challenging. Hence, the supplementary role of EGD with meticulous inspection for abnormalities is crucial in diagnosing gastrointestinal metastasis (see Figure 1, Table 1).Figure 1.: A pedunculated 2 x 3 cm polyp with central pitting and irregular border at the fundus. Table 1. - Literature Review of Hepatocellular Carcinoma Cases with Gastric Metastasis Mean age Male 77.46% Female 11.27% Initial presentation Gastrointestinal bleeding 36.62% Abdominal pain 8.45% Nausea/Vomiting 1.41% Palpable mass 1.41% Dysphagia 1.41% Fatigue 1.41% Weight loss 1.41% Fever 1.41% Not included 35.21% Primary diagnostic tool Endoscopy 54.93% CT scan 29.58% Laparotomy 4.23% Endoscopic features Ulcerative tumors 36.62% Tumors 12.68% Polyps 8.45% Ulcers 8.45% Protruding tumors 5.63% Submucosal tumors 4.23% Fistula 2.82% Unidentified 18.31% Gastric site Body 50.70% Antrum 7.04% Cardia 5.63% Unidentified 26.76%
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».