Bleeding gastric polyposis-like metastases of hepatocellular carcinoma

The first case ever described of symptomatic gastric polypoid metastases in a 62-year-old patient, who had undergone right hepatectomy for hepatocellular carcinoma (HCC) 2 years before, is reported. The patient presented recurrences of gastrointestinal bleeding. Barium meal and endoscopy showed multiple gastric polyps extending from the cardia to the pylorus. Histological examination of biopsies of these polyps resulted consistent with metastases of HCC. A total gastrectomy was performed for palliation of symptoms. Histo-pathological examination confirmed the presence of metastatic HCC: neoplastic nests implanted in the submucosa and extending towards the mucosa. The above observation supports that the possible route of spread in our patient could be hematogenous from reversed portal blood flow. The patient died 20 months after surgery, with liver recurrence of the tumor.