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Bone marrow metastasis presenting as bicytopenia originating from hepatocellular carcinoma
( Young Mi Hong ),( Ki Tae Yoon ),( Mong Cho ),( Dae Hwan Kang ),( Hyung Wook Kim ),( Cheol Woong Choi ),( Su Bum Park ),( Jeong Heo ),( Hyun Young Woo ),( Won Lim ),( Sm Bakhtiar Ui Islam ) 대한간학회 2016 Clinical and Molecular Hepatology(대한간학회지) Vol.22 No.2
The bone is a common site for metastasis in hepatocellular carcinoma (HCC). However, bone marrow metastasis from HCC is rarely reported, and its frequency is unclear. Here we report a rare case of bone marrow metastasis that presented as bicytopenia originating from HCC without bone metastasis. A 58-year-old man was admitted for investigation of a liver mass with extensive lymph node enlargement that was detected when examining his general weakness and weight loss. Laboratory findings revealed anemia, thrombocytopenia, mild elevated liver enzymes, normal prothrombin time percentage and high levels of tumor markers (α-fetoprotein and des-γ-carboxyprothrombin). Abdominal computed tomography showed multiple enhanced masses in the liver and multiple enlarged lymph nodes in the abdomen. A bone marrow biopsy revealed only a few normal hematopoietic cells and abundant tumor cells. Despite its rarity, bone marrow metastasis should always be suspected in HCC patients even if accompanied by cirrhosis. (Clin Mol Hepatol 2016;22:267-271)
( Su Jin Kim ),( Cheol Woong Choi ),( Dae Hwan Kang ),( Hyung Wook Kim ),( Su Bum Park ),( Young Mi Hong ),( Ki Tae Yoon ),( Mong Cho ),( Hyung Seok Nam ),( Sm Bakhtiar Ui Islam ) 대한간학회 2016 Clinical and Molecular Hepatology(대한간학회지) Vol.22 No.4
Background/Aims: This study aimed to evaluate the efficacy and safety of emergency variceal ligation for the prevention of rebleeding in cirrhotic patients who are found on initial endoscopy to have blood clots in the stomach but no actively bleeding esophageal and gastric varices or stigmata. Methods: This study included 28 cirrhotic patients who underwent emergency prophylactic EVL and 41 who underwent an elective intervention between January 2009 and June 2014. Clinical outcomes were analyzed, including the rebleeding, 6-week mortality, and rebleeding-free survival rates. Results: The rebleeding rate was higher in the emergency than in the elective group (28.6% vs. 7.3%, P=0.041). Multivariate analysis showed that emergency prophylactic EVL (odds ratio [OR] = 7.4, 95% confidence interval [CI]=1.634.8, P=0.012) and Child-Pugh score C (OR=10.6, 95% CI=1.4-80.8, P=0.022) were associated with rebleeding. In the emergency group, the gastric varices were associated with rebleeding (OR=12.0, 95% CI=1.7-83.5, P=0.012). Conclusions: Emergency EVL may be associated with variceal rebleeding when blood clots are present in the stomach without active esophageal and gastric variceal bleeding or stigmata. Elective intervention should be considered as a safer strategy for preventing variceal rebleeding in this situation. (Clin Mol Hepatol 2016;22:466-476)