Metastasis of Hepatocellular Carcinoma in the Pouch of Douglas Successfully Treated by Radiation Therapy: A Case Report

oleh: Hirayuki Enomoto, Masayuki Fujiwara, Hiroshi Kono, Yasukazu Kako, Motonori Takahagi, Junichi Taniguchi, Eri Ishikawa, Naoto Ikeda, Tomoyuki Takashima, Yukihisa Yuri, Nobuhiro Aizawa, Mamiko Okamoto, Kohei Yoshihara, Ryota Yoshioka, Shoki Kawata, Shogo Ota, Ryota Nakano, Hideyuki Shiomi, Takashi Nishimura, Seiichi Hirota, Koichiro Yamakado, Hiroko Iijima

Format: Article
Diterbitkan: MDPI AG 2023-01-01

Deskripsi

Metastasis of hepatocellular carcinoma (HCC) in the pouch of Douglas is relatively rare. A 65-year-old man with liver cirrhosis was admitted for detailed examination of a pelvic tumor. He had a previous history of ruptured HCC, and received emergent hemostasis with transcatheter arterial embolization followed by curative ablation. His blood tests showed an increase in des-gamma-carboxy prothrombin (DCP). Contrast-enhanced computed tomography (CE-CT) revealed a heterogeneously enhanced large pelvic tumor, but no additional tumorous lesions were detected in other organs, including the lungs, liver and abdominal lymph nodes. The colonoscopy showed compression by an extra-luminal/submucosal tumor, and computed tomography-guided percutaneous needle biopsy revealed that the pelvic tumor was metastasis of HCC. Because of the poor liver function, the solitary pelvic tumor was treated with three-dimensional conformal radiation therapy (3D-CRT). The tumor size and the DCP value were markedly decreased after radiation therapy. Nine months later, occasional mild bloody stool due to radiation proctitis was observed; however, no serious side effects occurred. Our case suggests that radiation therapy may be a therapeutic option for a solitary metastatic lesion of HCC in the pouch of Douglas.