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Adrenalectomy for solitary metastasis of Hepatocellular carcinoma post liver transplantation: Case report and literature review

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ABSTRACT

Liver transplantation (LT) is the treatment of choice for localized hepatocellular carcinoma (HCC) associated with cirrhosis. Extra hepatic metastasis is the most common cause of death in these patients. There is very little evidence regarding the natural history and treatment options for patients developing HCC recurrence after LT. Surgical resection offers a unique opportunity for solitary metastasis. We report a 61 year old male with solitary right adrenal metastasis 15 months post LT which was managed with open adrenalectomy. The patient is alive and disease free 24 months after the surgery. The case, histo-pathological findings and literature review is discussed.

No MeSH data available.


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Axial images of contrast enhanced CT, showing normal transplanted liver, spleen, left kidney and right adrenal mass abutting liver (arrow).
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Figure 1: Axial images of contrast enhanced CT, showing normal transplanted liver, spleen, left kidney and right adrenal mass abutting liver (arrow).

Mentions: Unfortunately, the patient did not follow a standardized surveillance protocol and was referred to us fifteen months post LT with an ultrasound scan revealing a right adrenal mass with normal serum AFP (1.0 IU/ml). He denied any history of weight loss, abdominal pain or hyper adrenergic symptoms. Contrast enhanced computerized tomography (CT) of chest and abdomen showed normal transplanted liver and an enhancing right adrenal mass with central necrosis measuring 30 x 33 x55 mm without any evidence of distant disease (Fig.1). A positron emission tomography (PET) scan confirmed the hyper metabolic lesion, raising suspicion of malignancy with standardized uptake value (SUV) of 4.5. The metabolic work-up was negative for pheochromocytoma, Cushing syndrome and Conn’s syndrome.


Adrenalectomy for solitary metastasis of Hepatocellular carcinoma post liver transplantation: Case report and literature review
Axial images of contrast enhanced CT, showing normal transplanted liver, spleen, left kidney and right adrenal mass abutting liver (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5017075&req=5

Figure 1: Axial images of contrast enhanced CT, showing normal transplanted liver, spleen, left kidney and right adrenal mass abutting liver (arrow).
Mentions: Unfortunately, the patient did not follow a standardized surveillance protocol and was referred to us fifteen months post LT with an ultrasound scan revealing a right adrenal mass with normal serum AFP (1.0 IU/ml). He denied any history of weight loss, abdominal pain or hyper adrenergic symptoms. Contrast enhanced computerized tomography (CT) of chest and abdomen showed normal transplanted liver and an enhancing right adrenal mass with central necrosis measuring 30 x 33 x55 mm without any evidence of distant disease (Fig.1). A positron emission tomography (PET) scan confirmed the hyper metabolic lesion, raising suspicion of malignancy with standardized uptake value (SUV) of 4.5. The metabolic work-up was negative for pheochromocytoma, Cushing syndrome and Conn’s syndrome.

View Article: PubMed Central - PubMed

ABSTRACT

Liver transplantation (LT) is the treatment of choice for localized hepatocellular carcinoma (HCC) associated with cirrhosis. Extra hepatic metastasis is the most common cause of death in these patients. There is very little evidence regarding the natural history and treatment options for patients developing HCC recurrence after LT. Surgical resection offers a unique opportunity for solitary metastasis. We report a 61 year old male with solitary right adrenal metastasis 15 months post LT which was managed with open adrenalectomy. The patient is alive and disease free 24 months after the surgery. The case, histo-pathological findings and literature review is discussed.

No MeSH data available.


Related in: MedlinePlus