Non-Cirrhotic Hepatocellular Carcinoma with Duodenal Metastasis in Chronic Hepatitis B: Case Report

Abstract

Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the second leading cause of cancer-related death. The extrahepatic extension is also more common in non-cirrhotic HCC. It most commonly metastases to the regional lymph nodes, bone, and lungs. Metastasis to the small bowel is rare. Further, hematogenous metastasis to the duodenum is incredibly rare. Case: A 67-year-old man was admitted with a recurrence of hematemesis melena, weight loss, weakness, and decreased appetite. There was a history of hepatitis and a family history of liver diseases. Abdominal examination revealed a palpable liver (8 cm below the right costal margin, firm, irregular, and tender). Laboratory studies revealed Hb 5.2 g/dL, SGOT 301.1 u/L, SGPT 244.7 u/L, albumin 2.7 g/dL, HbsAg was reactive with HBV DNA 2.01 x 104 IU/ml. EGD showed that esophageal varices were not visible, the duodenum showed an irregular mass, bleeding on touch, and many blood clots. Abdominal USG revealed hepatomegaly with suspicion of multifocal hepatoma, while a CT scan suggested the appearance of HCC and no local invasion into the small bowel. The result of the fibro scan was severe fibrosis, not cirrhosis. At laparotomy, a hepatic tumor and duodenum were discovered. The histopathological study of the tumor revealed a well-differentiated HCC. The resection of the tumor could not be done. He was given palliative and symptom treatment HCC on non-cirrhotic liver remains an exceptional condition. Conclusion: We report a non-cirrhotic HCC in chronic hepatitis B infection.