A case of duodenal metastasis from hepatocellular carcinoma

An 82-year-old man underwent follow-up evaluations for a lung tumor in the right lower lobe in 2018. In 2019, computed tomography (CT) revealed an irregularly elevated tumor in liver segment S8, which was diagnosed as hepatocellular carcinoma (HCC) with inferior vena cava thrombus. Proton therapy was initially performed for the HCC. In 2020 and 2021, transcatheter arterial chemoembolization (TACE) was performed for liver recurrence. In 2022, CT showed a portal vein thrombus, lymph node metastasis from the pancreatic head tumor, and duodenal metastasis from HCC. The patient then underwent chemotherapy. During chemotherapy, transfusion and superior inferior pancreaticoduodenal artery embolization were performed for bleeding from duodenal metastasis. After chemotherapy, CT showed complete remission of the portal vein thrombus and lymph node metastasis. The duodenal metastasis had grown. In 2023, we performed subtotal gastric-sparing pancreaticoduodenectomy for duodenal metastasis. A pathological examination revealed duodenal metastasis from HCC and no exposure to the serosa, although there was some infiltration outside the muscularis propria. The patient remains well with no evidence of tumor recurrence 1 year after resection. We suggest that resection of duodenal metastases may not only control bleeding, but also improve the prognosis through local control.