Gastric Lesion in a Patient with Advanced Hepatocellular Carcinoma

A 57-year-old male was diagnosed to have multifocal advanced hepatocellular carcinoma 1 year back and was on medical therapy. The patient presented at emergency with melaena upper gastrointestinal (GI) endoscopy demonstrated these lesions in antrum. What is the diagnosis?

The patient has been on Sorafenib 200 mg twice a day for almost 1 year. Upper GI endoscopy shows multiple geographic ulcers in antrum [Figure 1] radiating from pylorus almost like spokes of a wheel. There are likely to be drug-induced ulcers. Similar ulcers have been described earlier in GI tract though rare in the stomach.[1], [2] These lesions are distinct from Gastric antral vascular ectasia which are more common in patients with chronic liver disease. The patient was treated by argon plasma coagulation [Figure 2] along with supportive treatment.

Figure: Endoscopy showed multiple geographic ulcers in antrum

Figure: Endoscopic image post Argon Plasma coagulation

• REFERENCES

• 1 Kameda R, Ueno M, Kobayashi S, Ohkawa S. A case of multiple ulcer in the descending part of the duodenum following sorafenib administration for hepatocellular carcinoma. Dig Endosc 2012; 24: A2
• 2 Kang HY, Moon SH, Song IH. A unique bleeding-related complication of sorafenib, a tyrosine kinase inhibitor, in advanced hepatocellular carcinoma: A case report. J Med Case Rep 2014; 8: 72