Baylor College of Medicine/Beaumont Health (Royal Oak) Program Houston, TX, United States
Award: Presidential Poster Award
Alsadiq Al-Hillan, MD1, Alfarooq M. Alshaikhli, MD2, Nooraldin Merza, MD3, Shima Ghavimi, MD4, Shilpa Jain, MD5, Tejas V. Joshi, MD6 1Baylor College of Medicine/Beaumont Health (Royal Oak) Program, Houston, TX; 2University of Texas/ Rio Grande Valley (DHR), McAllen, TX; 3Wayne State University, Dearborn, MI; 4Marshall University Joan C. Edwards School of Medicine, Huntington, WV; 5Baylor College of Medicine, Houston, TX; 6Joan C. Edwards School of Medicine, Marshall University, Houston, TX
Introduction: Hepatocellular carcinoma is the most cause of primary cancer of the liver worldwide. HCC has a silent clinical course although can present with nonspecific symptoms or features of decompensation in patient with previously stable cirrhosis. HCC metastasis occurs by direct invasion, through hematogenous or lymphatic routes. Known sites of metastasis include lungs, brain, or lymph nodes. Direct invasion with the presence of liver lesion is the most common presentation. We report a case of imaging negative HCC diagnosed through investigation of Para-duodenal mass.
Case Description/Methods: An 84-year-old male with PMH of HCV cirrhosis presented with hematemesis, melena, and hematochezia. CT scan showed a 4.5x 2.9 cm enhancing lesion adjacent to the duodenum near the junction of the pancreatic head and body. EGD showed an infiltrating duodenal mass as the bleeding source and biopsy was completed. Pathology confirmed cells of hepatocellular origin in the form of HCC. MRI liver protocol didn’t reveal any discrete liver lesions. Alpha-fetoprotein (AFP) was negative.
Discussion: Over the years, detection of HCC has evolved significantly because of regular screening in patients with cirrhosis with regular cross-sectional imaging and AFP. Normal AFP levels are present in as many as 30% of patients at time of diagnosis. HCC metastasis occurs either through direct invasion, hematogenous or lymphatic routes. Extrahepatic manifestations occur in about 30-50% of cases, usually include lungs, regional lymph nodes, adrenal glands, and skeletal systems (vertebrae, ribs, and long bones). Establishing a diagnosis of HCC is usually made by a combination of serological testing and various imaging modalities. HCCs sometimes are not visualized on MR liver protocol, several studies reported sensitives of MR liver protocol around (60%-90%).
This case describes imaging-negative infiltrative HCC with normal AFP levels presenting primarily in the form of solo duodenal mass and was confirmed by mass biopsy.
Figure: HCC presented as duodenal mass with Negative MRI liver imaging.
Disclosures: Alsadiq Al-Hillan indicated no relevant financial relationships. Alfarooq Alshaikhli indicated no relevant financial relationships. Nooraldin Merza indicated no relevant financial relationships. Shima Ghavimi indicated no relevant financial relationships. Shilpa Jain indicated no relevant financial relationships. Tejas Joshi indicated no relevant financial relationships.
Alsadiq Al-Hillan, MD1, Alfarooq M. Alshaikhli, MD2, Nooraldin Merza, MD3, Shima Ghavimi, MD4, Shilpa Jain, MD5, Tejas V. Joshi, MD6. P2960 - A Case of Imaging-Negative Infiltrative HCC Presented as Duodenal Mass, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
