Extrahepatic-Growing Hepatocellular Carcinoma Presenting with Gastrointestinal Bleeding due to Penetration into the Gastric Lumen by the Tumor

Yoji Tamaki, Yoji Tabuse, Masakazu Sasaki, Kunihide Nakatsuka, Shinji Iwakura, Tomoo Shimomura

Department of Surgery, Minami-Wakayama National Hospital

An extremely rare case of extrahepatically growing hepatocellular carcinoma presenting with gastrointestinal bleeding due to penetration into the gastric lumen by the tumor is reported. The patient was a 66-year-old man who was examined by a local doctor for the main complaints of hematemesis and melena. Upper gastrointestinal fluoroscopy and endoscopy revealed a huge elevated lesion extending from the fornix to the posterior wall of the gastric corpus. The lesion, 13 cm in diameter, touched the lower surface of the lateral segment of the liver in abdominal computed tomography. The diagnosis of bleeding from the gastric submucosal tumor was made, and the patient was hospitalized for the purpose of undergoing surgery. At the time of hospitalization, distinct anemia was presented, and therefore, an emergency operation was performed. Under laparotomy, the tumor was found between the lateral segment of the liver and the posterior wall of the gastric corpus. As the tumor appeared to invade the lower surface of the lateral segment of the liver, resection of the lateral segment of the liver was performed in addition to total gastorectomy and splenectomy. Histological examination demonstrated that the tumor was a hepatocellular carcinoma of Edmondson's grade III, with extrahepaticaly growth from the lateral segment of the liver causing penetration into the gastric lumen.

Key words
extrahepatic-growing hepatocellular carcinoma, gastrointestinal bleeding, penetration into the gastric lumen

Reprint requests
Yoji Tamaki Department of Surgery, Minami-Wakayama National Hospital
2974 Takinai, Shinjo-cho, Tanabe-city, 646 JAPAN

Accepted
July 7, 1993

To read the PDF file you will need Abobe Reader installed on your computer.