title: Complete resection of hepatocellular carcinoma with direct invasion to the stomach remnant.
abstract: A 61-year-old man presented with anemia (hemoglobin, 5.9 mg/dl) and a history of alcoholic liver disease. The patient also had a past history of a distal gastrectomy and Billroth II reconstruction, due to a gastric ulcer, performed 20 years previously. Endoscopic gastroscopy revealed a hemorrhagic ulcerative tumor at the gastrojejunostomy site. Computed tomography and angiography demonstrated a 10-cm tumor and a 2-cm tumor in the left lateral segment of the liver, suggestive of hepatocellular carcinoma (HCC). The larger tumor showed extrahepatic growth, with invasion of the stomach remnant. Because transcatheter arterial embolization of the tumor failed to control the bleeding, we carried out an en-bloc resection of the left lateral segment of the liver and the stomach remnant. Direct invasion of HCC into the gastrointestinal tract is rarely encountered. Here we report a case of HCC that invaded the stomach remnant and present a review of the literature.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya 466-8550, Japan.
authors.forename: Kimihito
authors.initials: K
authors.lastname: Fujii
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Junichi
authors.initials: J
authors.lastname: Kamiya
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.forename: Norihiro
authors.initials: N
authors.lastname: Yuasa
authors.forename: Koji
authors.initials: K
authors.lastname: Oda
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D018530:Gastric Stump / Q000473:pathology / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*