Abouzied Moheieldin M, Fathala Ahmed, AlMuhaideb Ahmad, Almanea Hadeel, Al-Sugair Abdulaziz S, AlSkaff Rasha, Al-Qahtani Mohammed H
Department of Radiology, Medical Imaging Service, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Pathology and Laboratory Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Radiol Case Rep. 2020 Dec 22;16(3):550-554. doi: 10.1016/j.radcr.2020.12.047. eCollection 2021 Mar.
A 69-year-old male patient who had a history of well-differentiated hepatocellular carcinoma (HCC) post right hepatectomy presented a year later with iron-deficiency anemia. His anemia work-up included upper endoscopy that revealed multiple gastric polyp a biopsy from the largest demonstrated metastatic hepatocellular carcinoma. His magnetic resonance imaging (MRI) showed a gastric "polyp" without evidence of local HCC recurrence within the liver. His subsequent dual imaging with Choline/fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) confirmed the gastric metastases and in addition revealed other sites of unexpected metastatic disease in the right adrenal and the bone that was asymptomatic. Patient was started on sorafenib and currently he is alive one-and-half-year postdetection of his metastatic disease under palliative care. This case showed that the possibility of gastric metastases should be kept in mind when confronted with anemia in HCC patient and also highlight the complementary role of molecular imaging modality along with MRI in the metastatic work-up for hepatocellular carcinoma postcurative resection.
一名69岁男性患者，有右肝切除术后高分化肝细胞癌（HCC）病史，一年后出现缺铁性贫血。他的贫血检查包括上消化道内镜检查，发现多个胃息肉，对最大的息肉进行活检显示为转移性肝细胞癌。他的磁共振成像（MRI）显示一个胃“息肉”，肝脏内无局部HCC复发迹象。随后他进行的胆碱/氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）双成像证实了胃转移，此外还发现右肾上腺和骨骼有其他意外转移病灶，且无症状。患者开始服用索拉非尼，目前在检测到转移性疾病后接受姑息治疗已存活一年半。该病例表明，面对HCC患者的贫血时应考虑胃转移的可能性，同时也突出了分子成像模式与MRI在肝细胞癌根治性切除术后转移检查中的互补作用。
