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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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A: Tumour cells infiltrating into the normal adrenal gland parenchyma at the periphery H&E, 100 xM). B: Large lobules of neoplastic cells surrounded by rich sinusoidal network. Intracytoplasmic eosinophilic inclusions are also seen in large size, polygonal cells (H&E, 400 x M). C: Tumor cells (Right) staining positive for Cytokeratin CAM5.2 immunohistochemical stain while normal adrenal tissue (Left) are negative (200xM). D: Diffuse Hep-par1 positive immunohistochemical stain membranes and cytoplasmic (left) while normal adrenal tissue (right) is negative (H&E, 400 xM).
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Figure 2: A: Tumour cells infiltrating into the normal adrenal gland parenchyma at the periphery H&E, 100 xM). B: Large lobules of neoplastic cells surrounded by rich sinusoidal network. Intracytoplasmic eosinophilic inclusions are also seen in large size, polygonal cells (H&E, 400 x M). C: Tumor cells (Right) staining positive for Cytokeratin CAM5.2 immunohistochemical stain while normal adrenal tissue (Left) are negative (200xM). D: Diffuse Hep-par1 positive immunohistochemical stain membranes and cytoplasmic (left) while normal adrenal tissue (right) is negative (H&E, 400 xM).

Mentions: He underwent a right open adrenalectomy in March 2014 through right flank incision and histopathology revealed metastatic HCC with angio-lymphatic invasion (Fig.2). The patient made good recovery and was discharged. However he was advised to switch to Everolimus from FK506 as it decreases chances of HCC recurrence. After almost 39 months post-transplant he is doing well and under close surveillance.


Adrenalectomy for solitary metastasis of Hepatocellular carcinoma post liver transplantation: Case report and literature review
A: Tumour cells infiltrating into the normal adrenal gland parenchyma at the periphery H&E, 100 xM). B: Large lobules of neoplastic cells surrounded by rich sinusoidal network. Intracytoplasmic eosinophilic inclusions are also seen in large size, polygonal cells (H&E, 400 x M). C: Tumor cells (Right) staining positive for Cytokeratin CAM5.2 immunohistochemical stain while normal adrenal tissue (Left) are negative (200xM). D: Diffuse Hep-par1 positive immunohistochemical stain membranes and cytoplasmic (left) while normal adrenal tissue (right) is negative (H&E, 400 xM).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A: Tumour cells infiltrating into the normal adrenal gland parenchyma at the periphery H&E, 100 xM). B: Large lobules of neoplastic cells surrounded by rich sinusoidal network. Intracytoplasmic eosinophilic inclusions are also seen in large size, polygonal cells (H&E, 400 x M). C: Tumor cells (Right) staining positive for Cytokeratin CAM5.2 immunohistochemical stain while normal adrenal tissue (Left) are negative (200xM). D: Diffuse Hep-par1 positive immunohistochemical stain membranes and cytoplasmic (left) while normal adrenal tissue (right) is negative (H&E, 400 xM).
Mentions: He underwent a right open adrenalectomy in March 2014 through right flank incision and histopathology revealed metastatic HCC with angio-lymphatic invasion (Fig.2). The patient made good recovery and was discharged. However he was advised to switch to Everolimus from FK506 as it decreases chances of HCC recurrence. After almost 39 months post-transplant he is doing well and under close surveillance.

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