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Kim, Park, Kim, Kim, Lee, Hwang, and Shin: Adrenal Mass as Initial Presentation of Metastatic Hepatocellular Carcinoma: A Case Report
Case Report

Journal of the Korean Society of Magnetic Resonance in Medicine 2013; 17(4): 321-325.

Published online: 27 December 2013

DOI: https://doi.org/10.13104/jksmrm.2013.17.4.321

Adrenal Mass as Initial Presentation of Metastatic Hepatocellular Carcinoma: A Case Report

Hwan Yong Kim1, Chul Hi Park1, Min Ji Kim1, Yeo-Eun Kim1, Dong Hoon Lee1, Ho Kyung Hwang1, Dong Gue Shin2

1Department of Radiology, Seoul Medical Center, Seoul, Korea.

2Department of Surgery, Seoul Medical Center, Seoul, Korea.

Corresponding author: Chul Hi Park, M.D. Department of Radiology, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul 131-865, Korea. Tel. 82-2-2276-7236, Fax. 82-2-2276-7241, duruck70@hanmail.net

Received 30 September 2013       Revised 28 October 2013       Accepted 4 November 2013

Copyright © 2013 Journal of the Korean Society of Magnetic Resonance in Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Metastases from hepatocellular carcinoma (HCC) can be found in the multiple organs including adrenal gland. But adrenal metastasis of HCC without obvious hepatic lesion is very rare. We report CT and MR findings of a patient who presented with adrenal metastasis as the first clinical manifestation of HCC. Signal intensity and enhancement pattern of adrenal metastastic mass of HCC were similar to those of HCC on MRI.

Keywords: Hepatocellular carcinoma, Adrenal glands, Metastasis

Figures and Tables

Fig. 1
Initial dynamic CT finding.
a. An arterial phase image of dynamic contrast enhanced CT scan shows a nodular surface of the liver, which is suggestive of liver cirrhosis. No liver lesion is visualized.
b, c. Arterial and venous phase images of dynamic contrast enhanced CT scan shows an ovoid, well-defined heterogeneous enhancing mass (arrow) with central necrotic portion at left adrenal gland, measuring about 5.3 × 4.4 cm in size.
jksmrm-17-321-g001
Fig. 2
Follow-up dynamic contrast enhanced CT scan obtained 4 months after the initial CT.
a, b. Arterial and venous phase images of dynamic contrast enhanced CT scan demonstratesthat the mass (black arrow, a) has increased in size. An arterial phase image reveals a tubular enhancing lesion (white arrows, a) and a venous phase image shows wash-out lesion (white arrows, b) at left portal vein, which is suggestive of tumor thrombosis.
c. An arterial phase image of dynamic contrast enhanced CT scan shows an ill-defined heterogeneous enhancing mass (arrow) at segment 4 of the liver.
jksmrm-17-321-g002
Fig. 3
Gd-EOB-DTPA enhanced MR imaging findings.
a-f. Gd-EOB-DTPA-enhanced MR images show an ill-defined mass (white arrows) at segment 4 of the liver and an ovoid well-defined mass (black arrows) at left adrenal gland, with high signal intensity on T2-weighted image (a), low signal intensity on T1-weighted image (b), heterogeneous enhancement on arterial phase (c), low signal intensity on delayed phase (d), signal defect onhepatobiliary phase (e), and high signal intensity on diffusion-weighted image (f).
jksmrm-17-321-g003

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