Hepatocellular carcinoma (HCC) rarely invades the gastrointestinal (GI) tract. It occurs in 0.7% to 2% of clinical HCC cases. Moreover, gastric invasion with GI hemorrhage via peritoneal seeding is very rare. We report the case of 67-year-old woman who had a history of HCC rupture and was admitted due to left upper quadrant abdominal pain. The patient was diagnosed with three omental metastatic masses and underwent hepatic segmentectomy and omental tumorectomy. Two months later, the patient had massive melena, and an esophagogastroduodenoscopy showed very large ulcerated friable mass on the gastric body. The histology was consistent with the diagnosis of metastatic HCC. The patient died from persistent GI hemorrhage 93 days after the admission. This case illustrates the very rare event of peritoneal seeding of a ruptured HCC causing direct invasion of the stomach, followed by GI hemorrhage.
Aged ; Carcinoma, Hepatocellular/*diagnosis/radiography/secondary ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology/radiography ; Gastroscopy ; Humans ; Liver Neoplasms/*diagnosis/pathology/radiography ; *Neoplasm Seeding ; Peritoneal Neoplasms/*diagnosis/radiography/secondary ; Stomach Neoplasms/*diagnosis/radiography/secondary ; Tomography, X-Ray Computed

We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.
Adenocarcinoma/diagnosis/*secondary ; Adult ; Bone Neoplasms/*diagnosis/pathology/*secondary ; Case Report ; Female ; Human ; *Osteoblasts/radiography ; *Pelvis/radiography ; Radionuclide Imaging ; Stomach Neoplasms/*diagnosis ; Tomography, X-Ray Computed

We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.
Adenocarcinoma/diagnosis/*secondary ; Adult ; Bone Neoplasms/*diagnosis/pathology/*secondary ; Case Report ; Female ; Human ; *Osteoblasts/radiography ; *Pelvis/radiography ; Radionuclide Imaging ; Stomach Neoplasms/*diagnosis ; Tomography, X-Ray Computed

OBJECTIVE: To describe computed tomography (CT) features of metastatic gallbladder (GB) tumors (MGTs) from various primary tumors and to determine whether there are differential imaging features of MGTs according to different primary tumors. MATERIALS AND METHODS: Twenty-one patients who had pathologically confirmed MGTs and underwent CT were retrospectively enrolled. Clinical findings including presenting symptoms, type of surgery, and interval between primary and metastatic tumors were recorded. Histologic features of primary tumor and MGTs including depth of invasion were also reviewed. Imaging findings were analyzed for the location and morphology of MGTs, pattern and degree of enhancement, depth of invasion, presence of intact overlying mucosa, and concordance between imaging features of primary and metastatic tumors. Significant differences between the histologies of MGTs and imaging features were determined. RESULTS: The most common primary tumor metastasized to the GB was gastric cancer (n = 8), followed by renal cell carcinoma (n = 4) and hepatocellular carcinoma (n = 3). All MGTs (n = 21) manifested as infiltrative wall thickenings (n = 15) or as polypoid lesions (n = 6) on CT, similar to the features of primary GB cancers. There were significant differences in the morphology of MGTs, enhancement pattern, enhancement degree, and depth of invasion according to the histology of primary tumors (p < 0.05). Metastatic adenocarcinomas of the GB manifested as infiltrative and persistently enhancing wall thickenings, while non-adenocarcinomatous metastases usually manifested as polypoid lesions with early wash-in and wash-out. CONCLUSION: Although CT findings of MGTs are similar to those of primary GB cancer, they are significantly different between the various histologies of primary tumors.
Adenocarcinoma/pathology/radiography/secondary ; Adult ; Aged ; Carcinoma, Hepatocellular/pathology/radiography/secondary ; Carcinoma, Renal Cell/pathology/radiography/secondary ; Carcinoma, Squamous Cell/pathology/radiography/secondary ; Diagnosis, Differential ; Female ; Gallbladder Neoplasms/pathology/*radiography/*secondary ; Humans ; Kidney Neoplasms/pathology ; Liver Neoplasms/pathology ; Male ; Melanoma/pathology/radiography/secondary ; Middle Aged ; Neoplasm Invasiveness/radiography ; Retrospective Studies ; Stomach Neoplasms/pathology ; *Tomography, X-Ray Computed

Primary gastric carcinoma is the most common cause of linitis plastica. Less frequently, metastatic gastric cancer from the breast, omental metastases and non-Hodgkin lymphoma involving the stomach have been reported to show similar radiographic findings as for linitis plastica. A metastatic gastric cancer from bladder cancer is extremely rare. We present an unusual case, the first to our knowledge, of gastric linitis plastica that resulted from a metastatic urothelial carcinoma of the bladder.
Diagnosis, Differential ; Humans ; Linitis Plastica/radiography/*secondary ; Male ; Middle Aged ; Stomach Neoplasms/radiography/*secondary ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms/*pathology

Extrahepatic metastasis in patients with hepatocellular carcinoma (HCC) occurs frequently. The most common site of metastasis is the lung, followed by regional lymph nodes and bones. However, gastrointestinal metastasis of HCC is a rare condition and solitary polypoid metastatic lesion on stomach without any evidence of direct invasion from primary mass is very rare. These metastatic lesions are usually asymptomatic, and most are discovered at postmortem examination or are found incidentally during laparotomy. The choice of treatment for gastrointestinal metastatic lesion of HCC includes surgery, transarterial chemoembolization, and local injection but the treatment is often difficult and unsuccessful. We report a case of 69 years old man who presented disappearance of a polypoid metastatic lesion of HCC on the gastric fundus by transarterial chemoembolization.
Aged ; Carcinoma, Hepatocellular/*diagnosis/secondary/therapy ; *Chemoembolization, Therapeutic ; Duodenoscopy ; Gastric Fundus/radiography ; Humans ; Liver Neoplasms/*diagnosis/pathology/therapy ; Male ; Stomach Neoplasms/*diagnosis/secondary/therapy ; Tomography, X-Ray Computed

We report herein a case of hepatoid adenocarcinoma of the stomach with liver metastasis. Gastric carcinoma generally presents as adenocarcinoma and rarely shows a hepatoid pattern, which can produce alpha-fetoprotein (AFP). The stomach is one of the common sites at which hepatoid adenocarcinoma has been detected. A 75-year-old female patient was admitted to the hospital with a symptom of epigastric discomfort. Gastrofibroscopy revealed a large tumor occupying the greater curvature of the stomach body. The level of serum AFP was markedly increased. Abdominal computed tomography revealed multiple liver masses. Biopsy samples of the gastric lesion and liver masses finally confirmed her case as hepatoid adenocarcinoma in the stomach with liver metastasis. The AFP-producing gastric carcinoma needs special attention because it often presents with early liver metastasis and has a poor prognosis.
Adenocarcinoma/*diagnosis/pathology/radiography ; Aged ; Female ; Gastroscopy ; Humans ; Liver Neoplasms/*diagnosis/secondary/ultrasonography ; Lymphatic Metastasis ; Stomach Neoplasms/*diagnosis/pathology/radiography ; Tomography, X-Ray Computed ; alpha-Fetoproteins/metabolism

The cutaneous metastasis of a visceral malignancy to the umbilicus is known as "Sister Mary Joseph's nodule (SMJN)". It is considered to be a predictor of poor prognosis because it mostly occurs in advanced, metastasizing cancer. However, it is a very rare condition as an initial presenting sign of primary cancer. We recently encountered a 48-year-old man presented with an umbilical lump. The lesion was a firm, ill-delineated, painful nodule with regular surface in the umbilicus. Abdominal computed tomography showed a 2.2 cm sized, ill-defined, delayed enhancing mass at the periumbilical area accounting for umbilical nodule. Diffuse irregular thickening of peritoneum and diffuse wall thickening of stomach implied the diagnosis of gastric cancer. Esophagogastroduodenoscopy revealed diffuse nodular infiltrative lesion from cardia through body of the stomach, compatible with Bormann type 4 advanced gastric cancer. Later, histopathologic confirmation showed a presence of signet ring cell adenocarcinoma from biopsy specimens. We experiened a case presenting with an umbilical metastasis as the first sign of gastric adenocarcinoma. It is thought that direct extension of tumor through the peritoneum might be the route for umbilical metastasis. Careful examination of all umbilical lesions must be needed for the early diagnosis of internal malignancy.
Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Skin Neoplasms/diagnosis/pathology/*secondary ; Stomach Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed ; *Umbilicus/pathology/radiography

No abstract available.
Adenocarcinoma/*diagnosis/pathology ; Aged ; Carcinoma, Hepatocellular/diagnosis ; Humans ; Immunohistochemistry ; Liver Neoplasms/*radiography/secondary/ultrasonography ; Magnetic Resonance Imaging ; Male ; Stomach Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed ; alpha-Fetoproteins/analysis

No abstract available.
Adenocarcinoma/*diagnosis/radiography/secondary ; Adult ; Antineoplastic Agents/therapeutic use ; Breast Neoplasms/*diagnosis/drug therapy/pathology ; Carrier Proteins/metabolism ; Doxorubicin/therapeutic use ; Drug Therapy, Combination ; Endoscopy, Digestive System ; Female ; Glycoproteins/metabolism ; Humans ; Mastectomy, Modified Radical ; Positron-Emission Tomography and Computed Tomography ; Stomach Neoplasms/*diagnosis/radiography/secondary ; Taxoids/therapeutic use ; Tomography, X-Ray Computed