A 78-year-old man with history of hepatitis B infection was detected to have an abnormal liver function during his physical examination. After a close examination at our hospital, he was diagnosed with hepatocellular carcinoma. The patient was initially treated with transcatheter arterial chemoembolization, but due to an allergy to contrast media, it became difficult to continue the treatment, and he was treated with sorafenib. Seven months after initiation of sorafenib, lung metastasis was detected. He was treated with regorafenib and cabozantinib, but metastatic lung tumor increased in size. Immediately after initiation of atezolizumab and bevacizumab combination therapy, he had a melena and emergency esophagogastroduodenoscopy revealing a duodenal ulcer, which was treated with hemostasis. At that time, there were no other lesions that could have been the cause of the bleeding. After 11 months of continued treatment without duodenal ulcer recurrence, he again had a melena and anemia. Esophagogastroduodenoscopy revealed an elevated lesion approximately 2 cm in size in the upper gastric antrum (Figures A–C). Immunostaining of biopsy pathology showed Hep-par 1 positive, Glypican-3 positive, and Arginase-1 positive (Figure D), which led to the diagnosis of hepatocellular carcinoma metastasis. He is currently undergoing palliative radiotherapy for the purpose of hemostasis due to persistent anemia requiring blood transfusion.
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Publication history
Published online: October 31, 2022
Accepted:
October 26,
2022
Received:
October 20,
2022
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Conflicts of Interest: The authors disclose no conflicts.
Funding: The authors report no funding.
Ethical Statement: The corresponding author, on behalf of all authors, jointly and severally, certifies that their institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research.
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