{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:45:09Z","timestamp":1760147109078,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T00:00:00Z","timestamp":1673568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Metastasis of hepatocellular carcinoma (HCC) in the pouch of Douglas is relatively rare. A 65-year-old man with liver cirrhosis was admitted for detailed examination of a pelvic tumor. He had a previous history of ruptured HCC, and received emergent hemostasis with transcatheter arterial embolization followed by curative ablation. His blood tests showed an increase in des-gamma-carboxy prothrombin (DCP). Contrast-enhanced computed tomography (CE-CT) revealed a heterogeneously enhanced large pelvic tumor, but no additional tumorous lesions were detected in other organs, including the lungs, liver and abdominal lymph nodes. The colonoscopy showed compression by an extra-luminal\/submucosal tumor, and computed tomography-guided percutaneous needle biopsy revealed that the pelvic tumor was metastasis of HCC. Because of the poor liver function, the solitary pelvic tumor was treated with three-dimensional conformal radiation therapy (3D-CRT). The tumor size and the DCP value were markedly decreased after radiation therapy. Nine months later, occasional mild bloody stool due to radiation proctitis was observed; however, no serious side effects occurred. Our case suggests that radiation therapy may be a therapeutic option for a solitary metastatic lesion of HCC in the pouch of Douglas.<\/jats:p>","DOI":"10.3390\/life13010225","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T02:57:33Z","timestamp":1673578653000},"page":"225","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Metastasis of Hepatocellular Carcinoma in the Pouch of Douglas Successfully Treated by Radiation Therapy: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"given":"Hirayuki","family":"Enomoto","sequence":"first","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6782-7067","authenticated-orcid":false,"given":"Masayuki","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Kono","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7944-4381","authenticated-orcid":false,"given":"Yasukazu","family":"Kako","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, 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