S4424 An Unusual Report of Gastric Metastasis in Hepatocellular Carcinoma with Review of Literature
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.009 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".