Type III Cryoglobulinemia Associated with Non-Alcoholic Steatohepatitis in the Absence of Chronic Hepatitis C

revealed a poorly diff erentiated carcinoma consistent with the primary HCC. He remained clinically stable for 18 months when an abdominal CT revealed a mid-transverse colon mass. A colonoscopy performed prior to the hepatic resection removed 5 diminutive tubular adenomas. A repeat colonoscopy revealed a partially obstructing, malignant appearing mass. Biopsies revealed a poorly diff erentiated carcinoma consistent with metastatic HCC. Additionally, biopsies of the nodular mucosa in the cecum revealed lamina propria, intraepithelial and muscularis mucosal eosinophils. Th e peripheral eosinophil count was 24%. A transverse colectomy with primary anastomosis was performed. Th e specimen was described as an eccentric fungating lesion involving the full thickness of the bowel with gross invasion of the pericolic fat. Th ere were no other intra-abdominal masses or liver metastases. Conclusion: Th is is a rare case of extrahepatic HCC metastases occurring at 18 and 36 months following hepatic resection. Gastrointestinal involvement of HCC is highly unusual, occurring in 0.5-2% of cases. Th e most common site of GI involvement is the duodenum, followed by stomach and least oft en colon. Th e presumed mode of transmission is direct invasion of the GI tract. However, hematogenous spread to the colon has been speculated and is thought to have occurred in this patient. Awareness of the unusual occurrence of extrahepatic metastatic HCC is important to ensure adequate surveillance following primary resection.