400 The Korean Journal of Hepatology Vol. 16. No. 4, December 2010 in 70~90% of cases.14 In this case, the colonoscopy showed a bulging contoured tumor without any mucosal lesions, suspi- cious of extrinsic compression. The histopathologic findings were consistent with metastatic HCC, showing eosinophilic granular cytoplasm and large nuclei containing prominent nucleoli with immunopositivity for polyclonal CEA and hepatocyte antigen. According to previous reports, the interval between the diag- nosis of HCC and detection of GI tract involvement ranged from 3 months to 8 years.6,7,9 Mostly, GI metastasis is found in patients with advanced staged HCC. The prognosis of GI involvement from HCC is known to be poor with a median survival period of 7 months.15 However, it was suggested that treatment of extra- hepatic metastases may improve survival in some selected HCC patients who have good reserved function, intrahepatic tumor stage (T0-T2), and negative portal vein invasion.16 Similarly, a previous study reported that adrenalectomy for metastatic HCC resulted in improved survival rate especially in patients with well-controlled intrahepatic lesions at the time of adrenal meta- stasis and good general condition.17 Although there is little data regarding the efficacy of surgical treatment in patients with hae- matogenous colon metastasis from HCC, our case was treated with surgical management for the metastatic HCC because the patient had good hepatic reserved function and no other meta- static lesions. The patient has been free of recurrent disease to date for over 4 months. In conclusion, HCC with GI metastasis is uncommon and rarely spreads hematogenously to distant GI tracts. To date, the previously reported colonic metastases were located to the right side of the colon. Herein, to the best of our knowledge, we report the first case of solitary left-sided sigmoid colonic metastasis from HCC treated with surgical resection. REFERENCES 1. Bosch FX, Ribes J, Díaz M, Cléries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology 2004;127(Supple 1):S5-S16. 2. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003;362:1907-1917. 3. Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 2002;35:519-524. 4. Anthony PP. Primary carcinoma of the liver: a study of 282 cases in Ugandan Africans. J Pathol 1973;110:37-48. 5. Nakashima T, Okuda K, Kojiro M, Jimi A, Yamaguchi R, Sakamoto K, et al. Pathology of hepatocellular carcinoma in Japan. 232 consecutive cases autopsied in ten years. Cancer 1983;51:863-877. 6. Lin CP, Cheng JS, Lai KH, Lo GH, Hsu PI, Chan HH, et al. Gastrointestinal metastasis in hepatocellular carcinoma: radiological and endoscopic studies of 11 cases. J Gastroenterol Hepatol 2000;15: 536-541. 7. Chen LT, Chen CY, Jan CM, Wang WM, Lan TS, Hsieh MY, et al. Gastrointestinal tract involvement in hepatocellular carcinoma: clinical, radiological and endoscopic studies. Endoscopy 1990;22:118-123. 8. Nozaki Y, Kobayashi N, Shimamura T, Akiyama T, Inamori M, Iida H, et al. Colonic metastasis from hepatocellular carcinoma: manifested by gastrointestinal bleeding. Dig Dis Sci 2008;53:3265-3266. 9. Park MS, Kim KW, Yu JS, Kim MJ, Yoon SW, Chung KW, et al. Radiologic findings of gastrointestinal tract involvement in hepatocellular carcinoma. J Comput Assist Tomogr 2002;26:95-101. 10. Yang PM, Sheu JC, Yang TH, Chen DS, Yu JY, Lee CS, et al. Metastasis of hepatocellular carcinoma to the proximal jejunum manifested by occult gastrointestinal bleeding. Am J Gastroenterol 1987;82:165-167. 11. Sandler RS, Sartor RB, Bozymski EM. Endoscopic appearance of cancer metastatic to the stomach. J Clin Gastroenterol 1981;3(Suppl 1):35-37. 12. Hurlimann J, Gardiol D. Immunohistochemistry in the differential diagnosis of liver carcinomas. Am J Surg Pathol 1991;15:280-288. 13. Koelma IA, Nap M, Huitema S, Krom RA, Houthoff HJ. Hepatocellular carcinoma, adenoma, and focal nodular hyperplasia. Comparative histopathologic study with immunohistochemical parameters. Arch Pathol Lab Med 1986;110:1035-1040. 14. Kojiro M, Kawano Y, Isomura T, Nakashima T. Distribution of albumin- and/or alpha-fetoprotein-positive cells in hepatocellular carcinoma. Lab Invest 1981;44:221-226. 15. Natsuizaka M, Omura T, Akaike T, Kuwata Y, Yamazaki K, Sato T, et al. Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol 2005;20:1781-1787. 16. Uka K, Aikata H, Takaki S, Shirakawa H, Jeong SC, Yamashina K, et al. Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma. World J Gastroenterol 2007;13:414-420. 17. Park JS, Yoon DS, Kim KS, Choi JS, Lee WJ, Chi HS, et al. What is the best treatment modality for adrenal metastasis from hepatocellular carcinoma? J Surg Oncol 2007;96:32-36.