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CASE REPORT
 
Esophageal metastases of hepatocellular carcinoma following liver transplantation
Bruno Škurla1, Aleksandra Mlinarić1, Sergej Nadalin2, Miroslava Katičić1, Slavica Naumovski-Mihalić1
1Department of gastroenterology, Clinical hospital, Merkur, Zagreb, Croatia
2Department for Biology and Medical Genetics, School of Medicine, University of Rijeka, Croatia.

doi:10.5348/ijcri-2010-11-5-CR-2

Address correspondence to:
Aleksandra Mlinarić
Clinical Hospital, Merkur
I. Zajca 19
10000 Zagreb, Croatia
Phone/Fax: +38512431393
Email: aleksandramlinaric@yahoo.com

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How to cite this article:
Škurla B, Mlinarić A, Nadalin S, Katičić M, Naumovski-Mihalić S. Esophageal metastases of hepatocellular carcinoma following liver transplantation. International Journal of Case Reports and Images 2010;1(4):7-11.


Abstract
Introduction: Distal metastases occur in 30 to 75% cases of advanced hepatocellular carcinoma and the most common sites are the lungs, bones, intraperitoneal organs and adrenal gland. The most frequent metastases, except those mentioned above, are in the regional lymph nodes. Metastases to the esophagus are very rare, being present in less than 0.4% of patients with hepatocellular carcinoma.
Case Report: We present a case of a 56-year-old male patient who had been treated for alcoholic liver cirrhosis and hepatocellular carcinoma in cirrhotic liver, followed by orthotopic liver transplantation (OLT). Three months after OLT patient was admitted to the hospital due to anemia. The upper gastrointestinal endoscopy revealed two lesions in the lower part of the esophagus, of which the lesion at the cardia severely bleed. Sclerotherapy was the method of choice in order to stop bleeding which was followed by surgery after sclerotherapy failed. Biopsies of the esophageal lesions showed metastases of hepatocellular carcinoma, while multiple metastases in the lungs and the mediastinum had been diagnosed earlier. After the patient had recovered from surgery sorafenib was suggested as adjuvant therapy. The patient gave up on further treatment and eventually passed away.
Conclusion: The presently available scanning methods in severely ill patients will not always detect extrahepatic metastases of the liver cancer, thus causing an inappropriate use of liver transplantation. OLT failure resulting in spreading of the hepatocellular carcinoma will make us redefine the criteria for liver transplantation.

Key Words: Malignant diseases of the liver, Alcoholic liver cirrhosis, Hepatocellular carcinoma, Orthotopic liver transplantation, Esophageal metastases

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Author Contributions:
Bruno Škurla - Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Aleksandra Mlinarić - Conception and design, Acquisition of data, Analysis and interpretation of data, Critical revision of the article , Final approval of the version to be published
Sergej Nadalin - Conception and design, Acquisition of data, Analysis and interpretation of data, Critical revision of the article , Final approval of the version to be published
Miroslava Katičić - Analysis and interpretation of data , Drafting the article, Critical revision of the article, Final approval of the version to be published
Slavica Naumovski-Mihalić - Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of submission:
The corresponding author is the guarantor of submission.
Source of support:
None
Conflict of interest:
The author(s) declare no conflict of interests.
Copyright:
© Bruno Škurla et. al. 2010; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)