Case Report: Multimodal management of duodenal metastasis from hepatocellular carcinoma complicated by intractable hemorrhage.

Hepatocellular carcinoma with duodenal involvement is a rare clinical entity with limited treatment options. Here, we report a case of advanced hepatocellular carcinoma and portal vein tumor thrombus with metastatic involvement of the duodenum that resulted in a recurrent gastrointestinal hemorrhage in a 64-year-old male. Following comprehensive diagnostic evaluation, including endoscopy, imaging, and histopathological biopsy, the patient was managed with a multimodal approach that consisted of interventional embolization for hemostasis, followed by systemic immunotherapy with tislelizumab. This therapeutic strategy successfully achieved hemorrhage control and resulted in significant radiological regression of both the duodenal metastatic lesion and the primary hepatic tumor. This case highlights the importance of a systematic diagnostic approach and suggests that immunotherapy-based regimens may hold promise in the management of advanced hepatocellular carcinoma with uncommon metastatic manifestations.