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Case Report

Online Publishing Date:
03 / 07 / 2023

 


RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT

SHERINE E.K, AJIL ANTONY.


Abstract
Hepatocellular carcinoma can mimic benign lesions like liver haemangioma with atypical image findings and can manifest in an acute emergency where a diagnostic dilemma is encountered that can alter the phase of management. We hereby present a case of a 70-year-old male patient with multiple medical comorbidities who presented to us initially in June 2021 with a history of blunt trauma abdomen. Ultrasound abdomen imaging was suggestive of bleeding from liver hemangioma. The patient underwent emergency exploratory laparotomy and hemostasis was achieved. After being clinically better he underwent angioembolisation of the bleeding vessels; unfortunately, he presented one year later with bleeding per rectum. On re-evaluation, imaging features were again consistent with giant liver hemangioma infiltrating ascending and transverse colon. Tumour markers were negative. Being nonamenable to angioembolisation at this setting he underwent exploratory laparotomy unblock right hemicolectomy + non-anatomical liver resection (segment 6, part of 5,7) on October 2022 based on intraoperative findings. Surprisingly the histopathology report was that of hepatocellular carcinoma (HCC). Detailed searching made us able to find these sorts of discordant presentations of HCC with negative tumor markers and atypical imaging findings. The patient was referred to our medical oncology department for expert management. The incidence of direct invasion of HCC to the gastrointestinal tract is approximately 0.5–2%. Colonic metastasis is uncommon in patients with HCC. The diagnosis of HCC is generally made by radiologic hallmarks of dynamic contrast imaging. Sometimes large HCCs may have atypical radiological contrast enhancement patterns thus mimicking hemangioma.

Key words: HCC-Hepatocellular carcinoma, CT- Computed tomography, MRI- magnetic resonance imaging, TACE- Transarterial Chemoembolisation, GI- gastrointestinal, PLB-Percutaneous liver biopsy, AFP-Alpha fetoprotein


 
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Pubmed Style

E.K S, ANTONY A, . RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT. Int J Surg Med. Online First: 03 Jul, 2023. doi:10.5455/ijsm.136-1678908013

Web Style

E.K S, ANTONY A, . RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT. https://www.ejos.org/?mno=146510 [Access: February 20, 2024]. doi:10.5455/ijsm.136-1678908013

AMA (American Medical Association) Style

E.K S, ANTONY A, . RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT. Int J Surg Med. Online First: 03 Jul, 2023. doi:10.5455/ijsm.136-1678908013


Vancouver/ICMJE Style

E.K S, ANTONY A, . RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT. Int J Surg Med, [cited February 20, 2024]; Online First: 03 Jul, 2023. doi:10.5455/ijsm.136-1678908013


Harvard Style

E.K, S., ANTONY, A. & (2023) RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT. Int J Surg Med, Online First: 03 Jul, 2023. doi:10.5455/ijsm.136-1678908013


Turabian Style

E.K, SHERINE, AJIL ANTONY, and . 2023. RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT. International Journal of Surgery and Medicine, Online First: 03 Jul, 2023. doi:10.5455/ijsm.136-1678908013


Chicago Style

E.K, SHERINE, AJIL ANTONY, and . "RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT." International Journal of Surgery and Medicine Online First: 03 Jul, 2023. doi:10.5455/ijsm.136-1678908013


MLA (The Modern Language Association) Style

E.K, SHERINE, AJIL ANTONY, and . "RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT." International Journal of Surgery and Medicine Online First: 03 Jul, 2023. Web. 20 Feb 2024 doi:10.5455/ijsm.136-1678908013


APA (American Psychological Association) Style

E.K, S., ANTONY, A. & (2023) RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT. International Journal of Surgery and Medicine, Online First: 03 Jul, 2023. doi:10.5455/ijsm.136-1678908013


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