The Korean Journal of Hepatology 2010;16:397-400 DOI: 10.3350/kjhep.2010.16.4.397 Case Report Sigmoid colon metastasis from hepatocellular carcinoma Dong-Jun Yoo1, Young-Hwa Chung1, Yoon-Seon Lee1, Sung Eun Kim1, Young-Joo Jin1, Yu Mi Lee1, Mi-Jung Kim2 1Department of Internal Medicine and 2Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Hepatocellular carcinoma (HCC) is a major health problem worldwide, and it has a poor prognosis. Extrahepatic metastasis from HCC is not unusual, with direct invasion representing the main spreading mode. Sites that are frequently involved are the lung, bone, and lymph nodes. There are few reports of HCC invading the distant gastrointestinal tract, especially hematogenously. Herein we report a case of sigmoid colon metastasis from HCC. The patient was diagnosed with HCC and treated with transcatheter arterial chemoembolization (TACE). Eighteen months after TACE the patient presented with abdominal pain on the left lower quadrant, and a CT scan showed an enhanced mass on the sigmoid colon. Immunohistochemical staining revealed that a tumor cell was positive for polyclonal carcinoembryonic antigen and weakly positive for hepatocyte antigen, supporting the diagnosis of HCC metastasis. The patient underwent anterior resection for the metastatic HCC. (Korean J Hepatol 2010; 16:397-400) Keywords: Hepatocellular carcinoma; Metastasis; Sigmoid colon INTRODUCTION Hepatocellular carcinoma (HCC) is a serious health problem and has a poor prognosis. HCC accounts for 5.6% of all human cancers with more than 1 million deaths annually and the incidence of HCC is increasing.1,2 Despite the implementation of surveillance programs for early HCC, most tumors are diagnosed at intermediate or advanced stages, and only 30% of patients benefit from curative therapies such as resection, liver trans- plantation, or percutaneous ablation.2,3 In the previous autopsy series, extrahepatic metastasis was present in 30~70% of cases and the major organs involved were lung, lymph nodes, bone, and the adrenal gland.4,5 Interestingly, involvement of the gastrointestinal (GI) tract from HCC seldom occurs, being found in only 4~6% of cases in the same series4,5 and 0.5~2% of cases in another series.6,7 Among the GI meta- stasis from HCC, colon metastasis, especially the left-sided colon, is very rare and mostly occurs through direct invasion.8,9 Here, we report on a HCC patient who was treated with trans- arterial chemoembolization (TACE) and had a solitary metastatic tumor from HCC on his sigmoid colon one and a half years after initial treatment. CASE REPORT A 47-year-old man was admitted with a hepatic mass incidentally detected by ultrasound. A computed tomography (CT) scan revealed a 1.7 cm-sized mass in the hepatic segment VI with enhancement on the arterial phase and early washout on the portal phase (Fig. 1A), and a tiny enhancing nodule on the arterial phase without early washout on the portal phase in segment IV (Fig. 1B). The patient was a hepatitis B virus (HBV) carrier. Upon physical examination, superficial lymphadenectasis, icteric sclera, liver palm, or spider telangiectasias were not observed. The laboratory findings showed a slight elevation of transaminase (aspartate aminotransferase: AST 78 IU/L, alanine Received February 12, 2010; Revised July 1, 2010; Accepted July 13, 2010 Abbreviations: HCC, hepatocellular carcinoma; GI, gastrointestinal; TACE, transarterial chemoembolization; CT, computed tomography; HBV, hepatitis B virus; HBsAg, hepatitis B virus surface antigen; HBeAg, hepatitis B virus e antigen; AFP, alpha-fetoprotein; CEA, carcinoembryonic antigen Corresponding author: Young-Hwa Chung Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-2dong, Songpa-gu, Seoul 138-736, Korea Tel. +82-2-3010-3184, Fax. +82-2-476-0824, E-mail; yhchung@amc.seoul.kr Copyrights Ⓒ 2010 by The Korean Association for the Study of the Liver The Korean Journal of Hepatology∙pISSN: 1738-222X eISSN: 2093-8047