Polypoid Metastatic Hepatocellular Carcinoma of the Esophagus Occurring After Endoscopic Variceal Band Ligation

Abstract

This report describes a rare case of metastatic hepatocellular carcinoma (HCC) presenting as a polypoid mass in the lower esophagus after endoscopic variceal band ligation (EVL). A 56-year-old man underwent EVL for variceal bleeding in September 1993. He presented with dysphagia and tarry stool in December 1993.An endoscopic examination revealed a semipedunculated polypoid mass at the lower part of the esophagus, where EVL had been performed 3 months previously. The histologic examination at autopsy revealed that the polypoid mass consisted of metastatic HCC that had spread via the retrograde portal flow.

Unusual Metastasis of Hepatocellular Carcinoma to the Esophagus

“…However, there have been few reports on the endoscopic findings of premortem-diagnosed esophageal metastasis from HCC. A review of the literature indicated that the most common abnormal findings include a polypoid mass and a submucosal tumor (8)(9)(10). If endoscopic biopsy reveals a lack of available tumor tissue or poorly differentiated tissue, image evaluations such as CT, EUS, or angiography are necessary to differentiate between primary cancer and GI metastasis from HCC.…”

Hepatocellular Carcinoma with Gastrointestinal Involvement: A Systematic Review

“…Hiraoka, T. et al (1986) presented two cases of hepatocellular carcinoma with invasion of the portal vein branches, in which microscopic tumoral thrombi were found in sclerosed esophageal varices [20]. Kume, K. et al also presented a case of HCC metastases developed at the place of variceal band ligation [21].…”

Metastasis of Hepatocellular Carcinoma to the Esophagus: Case Report and Review

“…Metastatic esophageal tumors are usually located in the submucosal layer [ 7 ]; therefore, esophagography and endoscopy show severe luminal stricture with normal overlying mucosa, which often complicates histological diagnoses. A literature review indicated that the most common endoscopic findings of esophageal HCC metastases were polypoid or submucosal tumors [ 9 , 14 , 15 ]. If an endoscopic biopsy reveals a lack of available tumor cells, several imaging modalities, such as CT, endoscopic ultrasound, or angiography, are necessary to differentiate between primary esophageal cancer and HCC metastases [ 9 ].…”