Wada Yoshito, Matsugaki Satoru, Nagao Yuichi, Taniwaki Satoshi, Okuda Koji, Morimitsu Yosuke
Department of Surgery, Tobata Kyoritsu Hospital, 2-5-1 Sawami, Tobata-ku, Kitakyushu city, Fukuoka Prefecture 804-0093, Japan.
Department of Internal Medicine, Tobata Kyoritsu Hospital, 2-5-1 Sawami, Tobata-ku, Kitakyushu city, Fukuoka Prefecture 804-0093,Japan.
Int J Surg Case Rep. 2025 Jan;126:110491. doi: 10.1016/j.ijscr.2024.110491. Epub 2024 Oct 28.
Introduction and importance: Most extrahepatic metastases of hepatocellular carcinoma (HCC) are to the lungs and bones, metastases to the colon are rare. In the present study, we experienced a case of metastasis to the ascending colon during repeated treatment for HCC. Case Presentation: A 63-year-old man was diagnosed with multiple HCCs (T4N0M0 stage IIIB) associated with portal vein invasion. Transcatheter arterial chemoembolization (TACE), transarterial infusion (TAI) and radiofrequency ablation (RFA) were performed, and partial response was achieved, but the main nodule at S6 lesion subsequently recurred to protrude outside of the liver. A partial hepatic S6 resection was performed for local control 1.5 years after the initial treatment. IVR was then performed again, but approximately 8 months after hepatic resection, an abdominal computed toography (CT) showed a mass lesion in the ascending colon. After a total colonoscopy and biopsy, a diagnosis of colorectal metastasis of HCC was made. A right hemicolectomy was performed for local control. The patient had a good post-operative course, but developed liver failure due to rapid growth of the tumor thrombus of the main portal vein and died of primary disease approximately 3.5 months after the colon resection. Clinical Discussion: The metastasis of HCC to the colon is an extremely rare occurrence. Conclusion: One possible reason for this rarity is that portal vein tumor thrombosis (PVTT) results in colorectal metastasis via trans-portal retrograde metastasis.
肝细胞癌（HCC）的大多数肝外转移发生于肺和骨，转移至结肠者罕见。在本研究中，我们遇到1例在HCC反复治疗期间出现升结肠转移的病例。病例报告：一名63岁男性被诊断为伴有门静脉侵犯的多发性HCC（T4N0M0，IIIB期）。实施了经动脉化疗栓塞术（TACE）、经动脉灌注术（TAI）和射频消融术（RFA），并取得部分缓解，但S6段病变处的主要结节随后复发并突出至肝外。初始治疗1.5年后，为进行局部控制实施了S6段部分肝切除术。之后再次进行了经动脉化疗栓塞术，但在肝切除术后约8个月，腹部计算机断层扫描（CT）显示升结肠有一肿块病变。经全结肠镜检查及活检后，诊断为HCC结肠转移。为进行局部控制实施了右半结肠切除术。患者术后恢复良好，但因主门静脉肿瘤血栓快速生长而出现肝衰竭，在结肠切除术后约3.5个月死于原发性疾病。临床讨论：HCC转移至结肠极为罕见。结论：这种罕见情况的一个可能原因是门静脉肿瘤血栓形成（PVTT）通过门静脉逆行转移导致结肠转移。
