Hepatocellular carcinoma with unusual metastasis to the small intestine

An autopsy case of a hepatocellular carcinoma (HCC) with unusual metastasis to the mucosa of the small intestine is reported. The patient was a 73 year old female. At autopsy, the liver weighed 970 g, and an ovoid and necrotic 6 x 5 cm sized tumor was found in the right posterior lobe with many daughter tumors within the cirrhotic liver. The tumor embolus in the portal vein was not found. Extrahepatically the tumor metastasized to the lungs, sacral bone and hepatohillar and para-aortic lymph nodes. Additionally, many sessile and pedunculated polyps up to 2 cm in diameter were found sporadically in the small intestine. These seemed to be primary adenomatous polyps but histologically they were HCC metastasis. To the best of the authors' knowledge, many polypoid involvements of the small intestine by a hepatocellular carcinoma have not been reported until now.