Metastasis of hepatocellular carcinoma to the proximal jejunum manifested by occult gastrointestinal bleeding.

A 31-yr-old man, who had received left hepatic lobectomy for a ruptured hepatocellular carcinoma 17 months previously, began to have elevation of serum alpha-fetoprotein and occult gastrointestinal bleeding. Abdominal computed tomography, angiography, ultrasonography, upper gastrointestinal panendoscopy, colon-fiberscopy and endoscopic retrograde cholangiopancreaticography failed to disclose any recurrent intrahepatic tumor or bleeder in the gastrointestinal tract. However, a barium meal study revealed an intussusception with a suspicious nodular lesion in the proximal jejunum as the leading edge, which, after laparotomy, was proven to be a metastatic hepatocellular carcinoma and the cause of the gastrointestinal bleeding. The serosal side of this lesion was free from cancer involvement and there was no peritoneal implantation or lymph node involvement. The metastasis is probably hematogenous. The extremely unusual location involved by hepatocellular carcinoma in this patient signifies the ubiquitous nature of metastasis in this cancer.