title: Effect of immune suppression on metastasis in a patient with hepatocellular carcinoma metastasized to the colon and stomach: A case report.
abstract: Hepatocellular carcinoma (HCC) is a highly malignant cancer, which can invade the portal vein and cause liver/long bone metastasis, although digestive tract metastatic tumor from the liver is very rare. This case report describes an unusual case of HCC (clear cell type), determined by pathology of the original liver tumor resected on March 16th, 2004. The patient returned to our hospital in February and July 2009 complaining of 'black stool' in the first instance, and 'anemia' on the second occasion. Colonoscopy and gastroscopy indicated colon cancer and stomach cancer, respectively. The right half colon and distal stomach were resected, and pathological inspection revealed liver cancer metastasis. The patient succumbed to respiratory failure due to liver cancer lung metastasis on the May 23rd, 2013. Tests for CD4+and CD8+T cells and the CD4+/CD8+ratio, in addition to the expression of Fas, Fas ligand (FasL), indicated an evident difference in patient immunity during the tumor metastasis period. The disease progression in this patient suggested that immune surveillance may have been involved in the metastases. Furthermore, this case shows that clinicians should be alert to the possibility of metastases in uncommon sites that may be misdiagnosed as primary tumors. Surgical resection remains a valuable treatment for isolated digestive tract metastasis from liver cancer.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Cancer Hospital of Wuhan University (Hubei Cancer Hospital), Wuhan, Hubei 430079, P.R. China.
authors.forename: Dongde
authors.initials: D
authors.lastname: Wu
authors.affiliation: Department of Urology Surgery, Cancer Hospital of Wuhan University (Hubei Cancer Hospital), Wuhan, Hubei 430079, P.R. China.
authors.forename: Shaozhong
authors.initials: S
authors.lastname: Wei
authors.affiliation: School Hospital of Wuhan Textile University, Wuhan, Hubei 430073, P.R. China.
authors.forename: Baozhen
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Breast Cancer Surgery, Cancer Hospital of Wuhan University (Hubei Cancer Hospital), Wuhan, Hubei 430079, P.R. China.
authors.forename: Xinghong
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Breast Cancer Surgery, Cancer Hospital of Wuhan University (Hubei Cancer Hospital), Wuhan, Hubei 430079, P.R. China.
authors.forename: Yaojun
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Cancer Hospital of Wuhan University (Hubei Cancer Hospital), Wuhan, Hubei 430079, P.R. China.
authors.forename: Chenggang
authors.initials: C
authors.lastname: Luo
authors.affiliation: Department of General Surgery, First Hospital of Wuxue County, Huanggang, Hubei 435400, P.R. China.
authors.forename: Yiqing
authors.initials: Y
authors.lastname: Ju
authors.affiliation: Department of General Surgery, First Hospital of Wuxue County, Huanggang, Hubei 435400, P.R. China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Liang
keywords: colon metastasis; hepatocellular carcinoma; immunosuppression; prognosis; stomach metastasis