Clinical Case: Colonic Metastasis of Operated Hepatocellular Carcinoma

Background: Hepatocellular carcinoma (HCC) is the most common liver tumor and ranks as the second leading cause of cancer-related mortality worldwide due to its poor prognosis. Its prognosis is influenced by metastatic spread, mainly intrahepatic but also extrahepatic, which carries a more unfavorable prognosis. The most frequent hepatic metastases occur in the lungs, lymph nodes, bones, and adrenal glands. Atypical sites such as colonic involvement are exceptionally rare and scarcely documented in the literature. Case Presentation: A 60-year-old female was referred for an atypical hepatic lesion in segment VII, which developed in an otherwise healthy liver. She underwent laparoscopic right hepatectomy in 2016. In 2022, she presented with tumor recurrence, elevated AFP levels, and the appearance of a tumor nodule in the right hypochondrium, suggestive of peritoneal metastatic localization from her previously operated HCC. She underwent right colectomy, and histopathological analyses confirmed the metastatic nature of the lesion, not peritoneal but colonic. Conclusion: Elevated AFP levels in the context of HCC, even after surgery, should raise suspicion of metastatic recurrence, particularly extrahepatic. Even though rare, colonic metastasis could appear, sometimes in the form of very late recurrence. This underscores the importance of lifelong biological monitoring, including abdominal-pelvic CT scans.