Hepatocellular Carcinoma with Direct Invasion to the Duodenal Bulb, Presenting with Gastrointestinal Bleeding

Hemorrhage from hepatocellular carcinoma (HCC) directly invading the gastrointestinal tract is very rare. A 71-year-old man, who had been treated with transcatheter arterial embolization and percutaneous ethanol injection for HCC in the right hepatic lobe, presented with melena. Endoscopic examination showed a crater-like ulceration coated with blood clot in the duodenal bulb, and microscopic examina-tion of a biopsy specimen from the duodenal lesion con-firmed HCC. Abdominal computed tomography (CT) re-vealed that the HCC mass containing air-density invaded the duodenum. Recurrent bleeding continued from the le-sion and the patient died of liver failure. Postmortem ex-amination revealed massive HCC with hepatoduodenal fis-tula caused by direct tumor invasion into the duodenum. ACTA MEDICA NAGASAKIENSIA 46: 59-62, 200