Hepatocellular carcinoma with pancreatic mass as the first symptom: a case report and literature review

Abstract

Hepatocellular carcinoma (HCC) and primary pancreatic cancer are common malignant tumors of the digestive system. However, there are significant differences in treatment methods, medication types, and survival prognoses. For patients whose imaging findings suggest there to be a significant pancreatic mass and multiple masses in the liver, it can be easily misdiagnosed as a primary pancreatic cancer with liver metastasis in the clinic instead. Therefore, patients with a high likelihood of primary pancreatic cancer based on their clinical data, the pathological diagnosis should be confirmed through a needle biopsy as early as possible to avoid a misdiagnosis and possible mistreatment. In this study, our department admitted a patient with HCC that was characterized by a pancreatic occupation. The clinical data originally highly suggested primary pancreatic cancer with liver metastasis, but the final pathological puncture results had confirmed pancreatic metastasis of HCC. This case reminds us that a pathological biopsy should still be used as the final means of definite diagnosis and should be widely popularized for pancreatic nodules.

An Atypical Presentation of Hepatocellular Carcinoma with Multisite Metastasis following a Curative Liver Transplant

“…HCC is the most common primary liver cancer and the second most common cause of death from all malignancies. [1][2][3] Treatments for HCC vary based on initial staging, but transplants tend to be curative when the disease is confined to the liver. Selection for liver transplantation has traditionally been based on tumor size and number according to the Milan criteria.…”

“…The most common sites for extrahepatic metastases are lungs, abdominal lymph nodes, bone, and adrenal glands. 1,2,[8][9][10][11] Gastric and pancreatic metastases are particularly rare, especially after curative liver transplantation. Gastric metastasis from HCC was first reported in 1985 with 0.08% reported incidence.…”

“…9,[13][14][15] Similarly, the incidence of pancreatic metastasis from HCC is reported as 2.7 to 5.6%, either synchronous metastases at the time of primary tumor diagnosis or detected as an incidental finding on autopsy. 1,11,16 It is difficult to differentiate primary from metastatic pancreatic malignancy as they have similar clinical and imaging presentations, although the treatment and prognosis differ. 1 Pathological diagnosis with immunohistochemical staining remains the mainstay of differentiating these.…”

“…1,11,16 It is difficult to differentiate primary from metastatic pancreatic malignancy as they have similar clinical and imaging presentations, although the treatment and prognosis differ. 1 Pathological diagnosis with immunohistochemical staining remains the mainstay of differentiating these. 1 While there is no standard protocol to monitor HCC recurrence in transplant patients, often a combination of serum AFP levels and ultrasound or magnetic resonance imaging is used for surveillance due to poor sensitivity and specificity of AFP levels alone.…”

Simultaneous multiple primary malignancies diagnosed by endoscopic ultrasound-guided fine-needle aspiration: A case report

“…The absence of EUS-FNA for liver biopsy may be due to the location of her liver lesion. In addition, Zhang et al [ 10 ] reported a 70-year-old man with pathologically confirmed pancreatic metastasis of hepatocellular carcinoma. Therefore, in patients with pancreatic masses and multiple liver nodules, clinicians should consider the following three possibilities: Primary pancreatic cancer with liver metastasis, primary liver cancer with pancreatic metastasis, and MPMs.…”