Metastatic hepatocellular carcinoma manifesting as primary esophageal carcinoma: A rare case report

Hepatocellular carcinoma (HCC) metastasizing to the esophagus and mimicking as a primary tumor of the esophagus is extremely rare, being present in <0.4% in some autopsy series. This report describes a case of 70-year-old male with metastatic HCC to esophagogastric junction causing diagnostic dilemma. An endoscopic examination revealed an ulcerative lesion in the lower end of the esophagus. The biopsy specimen obtained from a tumor revealed the pseudoglandular arrangement of tumor cells. Ultrasound abdomen showed liver nodule with biopsy confirming as HCC. Immunohistochemistry (IHC) of the esophageal mass showed positivity for Hep par 1, Glypican-3, Arginase, CA 19-9, CK 19, CDX2, pCEA, SATB2, and Ki-67 having 70% positivity confirming the HCC. Among these IHC panels, all are specific markers of HCC, but CDX2 and SATB2 were aberrantly expressed in our case. He was started on six cycles of chemotherapy (apristar 125 mg, epirubicin 40 mg, oxaliplatin 100 mg, and capecitabine 500 mg). After 8 months of follow-up, he was symptomatically improved. However, later, the patient was lost to follow-up. The accurate pretreatment staging and then providing stage-appropriate treatment is crucial in optimizing esophageal and hepatocellular cancer outcomes. Cases of premortem-diagnosed esophageal metastasis from HCC are extremely rare. Our case was ideal for IHC, which plays an important role in arriving at proper cases. Furthermore, it confirmed and highlighted the rare manifestations of hepatocellular carcinoma.