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Hepatocellular carcinoma directly invading the duodenum
Abdelrahman O Mohamed1, Sandhya Joshi, Janusz Czechowski
1Department of Internal Medicine, Al-Ain Teaching Hospital, PO Box 17302, Al-Ain, United Arab Emirates. abduusman@hotmail.com
Insights
Hepatocellular carcinoma (HCC) invading the duodenum is a rare cause of recurrent upper gastrointestinal bleeding. This case highlights a duodenal mass from HCC leading to severe bleeding, weight loss, and anemia in a patient with chronic hepatitis C.
Area of Science:
- Hepatology
- Gastroenterology
- Oncology
Background:
- Hepatocellular carcinoma (HCC) is a primary liver cancer often associated with chronic hepatitis C.
- Gastrointestinal bleeding is a known complication of advanced liver disease, typically from esophageal varices.
- Duodenal invasion by HCC is an exceptionally rare presentation.
Observation:
- A 50-year-old male with chronic hepatitis C presented with recurrent upper gastrointestinal tract (UGIT) bleeding, weight loss, and anemia.
- Endoscopy revealed non-bleeding esophageal varices and a large, ulcerated duodenal mass.
- The duodenal mass partially obstructed the duodenal bulb outlet.
Findings:
- Pathological evaluation confirmed the duodenal mass to be hepatocellular carcinoma (HCC).
- The HCC invasion of the duodenum was the direct cause of the severe UGIT bleeding.
- This presentation is highly unusual, as duodenal invasion by HCC is not a common occurrence.
Implications:
- This case underscores the importance of considering rare diagnoses in patients with known liver disease and gastrointestinal bleeding.
- Early recognition and diagnosis of duodenal HCC are crucial for appropriate management.
- Further research may be needed to understand the mechanisms and outcomes of duodenal invasion by HCC.
Abstract:
Recurrent gastrointestinal bleeding from hepatocellular carcinoma HCC invading the duodenum is very rare. We present a case of 50-year-old male who was admitted with a history of recurrent upper gastrointestinal tract UGIT bleeding, weight loss and anemia. The patient was known to have a chronic hepatitis C. Endoscopic examination showed grade-2 non-bleeding esophageal varices, and a large ulcerated duodenal mass partially obstructing the duodenal bulb outlet and causing recurrent UGIT bleeding. Pathological evaluation of the mass revealed HCC.