Journal List > Korean J Gastroenterol > v.59(4) > 1006941

Ahn, Jung, Choi, Choi, Seo, Kim, Cho, and Kim: Adrenal Metastasis from Hepatocellular Carcinoma without Intrahepatic Recurrence after Hepatic Resection

Abstract

Although the adrenal gland is a common site of metastasis from hepatocellular carcinoma (HCC), adrenal metastases are rarely seen in clinical practice because of its lower metastatic potential compared to the other malignancies. Adrenal metastases usually were detected at the time of diagnosis of primary HCC or simultaneously with intrahepatic recurrence after curative management of HCC. It is very rare that only metastatic HCC is detected without evidence of intrahepatic recurrence. Hereby, we report two cases of adrenal metastasis from HCC without intrahepatic recurrence after hepatic resection.

Figures and Tables

Fig. 1
(A) Abdominal CT showed a huge mass in the left lobe of the liver. (B) Histologic examination of resected tumor showed hepatocellular carcinoma of trabecular pattern (H&E, ×200).
kjg-59-308-g001
Fig. 2
(A) Abdominal CT, taken 7 months after operation, revealed no evidence of recurrence in the liver. (B) CT showed a 2.5 cm sized right adrenal mass. (C) Positron emission tomography-CT revealed no abnormal hypermetabolism and no evidence of metastasis except right adrenal gland. (D) Microscopic finding of resected right adrenal gland revealed similar tumor pattern to primary tumor (H&E, ×200).
kjg-59-308-g002
Fig. 3
(A) Abdominal CT showed 3 cm sized mass in the right posterosuperior area (segment VII) of the liver. (B) Histologic examination of resected tumor showed hepatocellular carcinoma of trabecular pattern (H&E, ×200).
kjg-59-308-g003
Fig. 4
(A) Abdominal CT, taken 24 months after operation, revealed no evidence of recurrence in the liver. (B) CT showed a 4 cm sized left adrenal mass. (C) Positron emission tomography-CT revealed no abnormal hypermetabolism and no evidence of metastasis except left adrenal gland. (D) Microscopic finding of resected left adrenal gland revealed similar tumor pattern to primary tumor (H&E, ×200).
kjg-59-308-g004

Notes

Financial support: None.

Conflict of interest: None.

References

1. Uka K, Aikata H, Takaki S, et al. Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma. World J Gastroenterol. 2007. 13:414–420.
2. Uchino K, Tateishi R, Shiina S, et al. Hepatocellular carcinoma with extrahepatic metastasis: clinical features and prognostic factors. Cancer. 2011. 117:4475–4483.
3. Katyal S, Oliver JH 3rd, Peterson MS, Ferris JV, Carr BS, Baron RL. Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000. 216:698–703.
4. Bruix J, Sherman M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005. 42:1208–1236.
5. Momoi H, Shimahara Y, Terajima H, et al. Management of adrenal metastasis from hepatocellular carcinoma. Surg Today. 2002. 32:1035–1041.
6. Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg. 2003. 238:703–710.
7. Gao ZH, Tretiakova MS, Liu WH, Gong C, Farris PD, Hart J. Association of E-cadherin, matrix metalloproteinases, and tissue inhibitors of metalloproteinases with the progression and metastasis of hepatocellular carcinoma. Mod Pathol. 2006. 19:533–540.
8. Liu YB, Gao SL, Chen XP, et al. Expression and significance of heparanase and nm23-H1 in hepatocellular carcinoma. World J Gastroenterol. 2005. 11:1378–1381.
9. Pandey D, Tan KC. Surgical resection of adrenal metastasis from primary liver tumors: a report of two cases. Hepatobiliary Pancreat Dis Int. 2008. 7:440–442.
10. Rubio E, González J, Jimenéz M, et al. Right adrenal metastases of hepatocarcinoma after liver transplantation: case report and literature review. Transplant Proc. 2009. 41:1067–1069.
11. Lam CM, Lo CM, Yuen WK, Liu CL, Fan ST. Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma. Br J Surg. 1998. 85:1198–1200.
12. Park JS, Yoon DS, Kim KS, et al. What is the best treatment modality for adrenal metastasis from hepatocellular carcinoma? J Surg Oncol. 2007. 96:32–36.
13. Chan KM, Yu MC, Wu TJ, et al. Efficacy of surgical resection in management of isolated extrahepatic metastases of hepatocellular carcinoma. World J Gastroenterol. 2009. 15:5481–5488.
14. Schwartz JD, Schwartz M, Mandeli J, Sung M. Neoadjuvant and adjuvant therapy for resectable hepatocellular carcinoma: review of the randomised clinical trials. Lancet Oncol. 2002. 3:593–603.
15. Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009. 10:25–34.
16. Llovet JM, Ricci S, Mazzaferro V, et al. SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008. 359:378–330.
TOOLS
Similar articles