A C demonstrated sheets of large polygonal tumor cells arranged in a trabecular pattern. The tumor cells exhibited eosino- philic, granular cytoplasm and large nuclei containing prominent nucleoli, resembling HCC (Fig. 3B). The tumor cells were pos- itive for polyclonal carcinoembryonic antigen (pCEA, 1:800, Dako, Glostrup, Denmark) and weakly positive for hepatocyte antigen (1:200, Dako, Denmark), supporting the diagnosis of HCC (Fig. 3C). There was no regional lymph node metastasis at the time of surgery and the patient is free of recurrent disease to date for over 4 months. DISCUSSION HCC with hematogeous metastasis to colon is very rare. This case shows the typical findings of HCC metastasis to sigmoid colon. Extrahepatic metastasis of HCC is increasing with prolonged survival and the most frequent sites of metastases are lung, bone, and lymph nodes. On the other hand, GI involvement of HCC is known to be not common. The major mode of metastasis to the Dong-Jun Yoo, et al. Sigmoid colonic metastasis from HCC 399 B Figure 3. Histopathology of metastatic HCC. (A) Gross specimens of sigmoid colon metastasis showing a well-defined subserosal mass. (B) The tumor cells had eosinophilic granular cytoplasms and large nuclei containing prominent nucleoli, resembling HCC (hematoxylin-eosin stain; ×400), and (C) they were positive for polyclonal carcinoembryonic antigen (pCEA) (×100). GI tract is direct invasion to the contiguous GI tract via adhesion to the serosal side by a bulky tumor mass and the most frequently involved site was the duodenum, followed by the stomach, colon, and jejunum.6 Rarely, it is hypothesized that HCC may dissem- inate hematogenously to distant GI tracts. Portal vein thrombosis may be the key point of hematogenous spread to other sites.7,10 In our case, it is notable that the HCC was initially a small sized sin- gle mass without portal vein thrombosis and metastasized to the left-sided colon one and a half years after TACE. Hematogenous spread was suggested because the metastatic site was distant and the lymph nodes were not involved. Endoscopic findings of GI metastasis from HCC were varied, such as a raised and centrally ulcerated lesion, mimicking gastric carcinoma, polypoid tumor, or submucosal tumor.7,11 Therefore, immunohistochemical findings are important to differentiate HCC from adenocarcinoma in the diagnosis of GI metastasis. Typically, in HCC, Cam 5.2 staining is positive whereas AE1/AE3 staining is negative.12 Polyclonal CEA is highly specific for the lining of the biliary canaliculi.13 Similarly, AFP is another reliable indicator for HCC and it has been reported to be positive