Radiologic findings of gastrointestinal tract involvement in hepatocellular carcinoma

The purpose of this work was to evaluate the radiologic findings of gastrointestinal (GI) tract involvement in hepatocellular carcinoma (HCC) and to discuss mechanisms of spread.

Eighteen patients with histologically proven GI tract metastasis in HCC for 4.5 years underwent CT and five also underwent upper GI (UGI) series. The cases were classified according to the mode of spread, based on the radiologic findings.

The involved portion of the GI tract was the stomach (n = 11), duodenum (n = 4), and colon (n = 4). The mode of spread was direct invasion from a contiguous primary tumor (n = 12), hematogenous metastasis (n = 3), peritoneal seeding (n = 1), and undetermined (n = 2). In cases of direct invasion from contiguous primary tumors, CT revealed GI tract invasion directly from bulky hepatic masses (n = 9) or daughter masses at the portion of the bowel wall contiguous to the hepatic masses (n = 3). In cases of hematogenous spread, CT revealed an intramural mass in the stomach and duodenum (n = 2) or a diffuse thickening of the wall of the stomach (n = 1). In the case of peritoneal seeding, CT revealed multiple small nodules in the right paracolic gutter, omentum, and mesentery with invasion to the colon.

GI tract involvement in HCC shows various radiologic findings according to the mode of spread, but the most common finding is direct invasion of the stomach, duodenum, or colon from contiguous primary tumor.