Although a metastasis to the gastrointestinal tract (GI) is rare in patients with hepatocellular carcinoma (HCC), it can occur by hematogenous or lymphatic spread, or by direct invasion of a tumor. A 61-year old woman who had a progressing large primary liver cancer presented with upper gastrointestinal (UGI) bleeding. UGI endoscopy showed a large duodenal submucosal tumor-like mass with a central ulcer and adherent blood clots. Endoscopic biopsy and coagulation using argon plasma probe were performed. The microscopic examination revealed a HCC. We report this unusual case of HCC with direct invasion of the duodenum.
Argon ; Biopsy ; Carcinoma, Hepatocellular* ; Duodenum* ; Endoscopy ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Liver Neoplasms ; Middle Aged ; Neoplasm Metastasis ; Plasma ; Ulcer

Biliary bezoar is a rare event that can cause cholangitis and pancreatitis. Biliary bezoar occurs infrequently by food material reflux and bile stasis following choledochoenterostomy, choledochoduodenal fistula, endoscopic sphincterotomy, duodenal diverticula, and because of suture remnants. We describe a phytobezoar in the common bile duct following percutaneous transhepatic large balloon papillary dilatation, which was successfully removed using an endoscopic procedure.
Bezoars ; Bile ; Cholangitis ; Common Bile Duct ; Dilatation ; Diverticulum ; Fistula ; Pancreatitis ; Sphincterotomy, Endoscopic ; Sutures