title: Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) tends to metastasize to extrahepatic organs. Stomach involvement has been seldom reported and has always been considered as direct invasion. This study aims to propose a possible existing pathway for the hematogenous metastasis of HCC to the stomach.
  
  
  METHODS
  Only seven cases with stomach involvement were found from 8267 HCC patients registered at our hospital between 2000 and 2007. Their laboratory data, the findings of computed tomography and upper endoscopy, therapeutic procedures, such as esophageal variceal banding ligation (EVL), and transhepatic arterial embolization (TAE) were further studied.
  
  
  RESULTS
  All seven patients were male. Liver cirrhosis was found in six patients (6/7 = 85.7%), HCC with portal vein thrombosis (PVT) in six patients (6/7 = 85.7%), splenomegaly in five patients (5/7 = 71.4%) and esophageal varices in five patients (5/7 = 71.4%). Six patients underwent TAE and one patient underwent EVL before the development of HCC in the stomach. Four patients had HCC at the cardia, one patient at the anterior wall of the high body and two patients at the greater curvature of the high body, far away from the original HCC. Six patients eventually developed distant metastasis. HCC with gastric metastasis developed 53-126 days after TAE in five patients and 74 days after EVL in one patient.
  
  
  CONCLUSIONS
  When cirrhotic patients with portal hypertension have HCC with PVT, a hematogenous pathway can exist for gastric metastasis of tumor thrombi involving hepatofugal flow to the stomach after TAE or EVL apart from the major pathway of direct invasion.
authors.affiliation: Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.
authors.forename: Ming-Luen
authors.initials: ML
authors.lastname: Hu
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Tai
authors.forename: Seng-Kee
authors.initials: SK
authors.lastname: Chuah
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chiu
authors.forename: Keng-Liang
authors.initials: KL
authors.lastname: Wu
authors.forename: Yeh-Pin
authors.initials: YP
authors.lastname: Chou
authors.forename: Chung-Mou
authors.initials: CM
authors.lastname: Kuo
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.forename: King-Wah
authors.initials: KW
authors.lastname: Chiu
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000556:secondary* / Q000628:therapy; D013505:Digestive System Surgical Procedures; D004621:Embolization, Therapeutic; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000473:pathology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000473:pathology; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D008297:Male; D011169:Portal Vein; D013163:Splenomegaly / Q000209:etiology / Q000473:pathology; D013274:Stomach Neoplasms / Q000556:secondary* / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000473:pathology