title: Massive upper gastrointestinal hemorrhage due to invasive hepatocellular carcinoma and hepato-gastric fistula.
abstract: A 36-year-old male Asian immigrant with a history of hepatitis B and hepatitis C related unresectable hepatocellular carcinoma in the left lobe of the liver presented with hematemesis and severe anemia. He was diagnosed with a liver mass that was resected 8 years ago described as a benign tumor in his home country. He had received trans-arterial chemoembolization (TACE) four months ago after subsequent diagnosis of unresectable hepatoma, and currently was receiving chemotherapy with Sorafenib. After resuscitation, a contrast enhanced computerized tomography was performed which showed fistulization of hepatocellular carcinoma into adjacent stomach. This finding was confirmed during endoscopy with direct visualization of the fistulous opening. Hepatocellular carcinoma (HCC) invading the gastrointestinal (GI) tract is rare. We present a case and literature review of HCC with local invasion of the stomach causing massive upper GI bleeding after receiving TACE.
authors.affiliation: Hari Sayana, Osama Yousef, Wendell K Clarkston, Section of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO 64108-2640, United States.
authors.forename: Hari
authors.initials: H
authors.lastname: Sayana
authors.forename: Osama
authors.initials: O
authors.lastname: Yousef
authors.forename: Wendell K
authors.initials: WK
authors.lastname: Clarkston
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology / Q000628:therapy / Q000821:virology; D016461:Chemoembolization, Therapeutic; D016145:Endoscopy, Digestive System; D005747:Gastric Fistula / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy / Q000821:virology; D008297:Male; D009361:Neoplasm Invasiveness; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Fistula; Hepatocellular carcinoma; Hepatogastric fistula; Upper gastrointestinal bleeding