Surgical treatment of adrenal metastases from hepatocellular carcinoma

Česká verzia

Authors: J. Pudil ¹; F. Bělina ¹; K. Hlavová ²
Authors place of work: Chirurgická klinika 2. LF UK a ÚVN Praha ¹; Interní klinika 1. LF UK a ÚVN Praha ²
Published in the journal: Gastroent Hepatol 2013; 67(2): 115-117
Category: Hepatology: Case Report

Summary

Introduction:
The hepatocellular carcinoma (HCC) is the most common primary tumour of the liver. Radical resection or transplantation remains the sole curable method. The authors present an unusual case report of HCC metastasis.

Case report:
A 60-year-old man with chronic hepatitis C was indicated for liver resection due to a solitary HCC tumour. Significant elevations of AFP were observed four months after the operation, with the check-up CT showing a metastatic process in both adrenals. We performed bilateral adrenalectomy. Histological findings confirmed HCC metastasis.

Discussion:
The adrenal is the usual place of haematogenous HCC metastasis; however, it is rarely observed in clinical practice. Bilateral adrenalectomy due to adrenal metastases is only described as case reports in Asian literature. The method of choice in both unilateral and bilateral adrenalectomies is the mini-invasive approach.

Conclusion:
HCC is a disease that has been showing increasing incidence; nevertheless, bilateral adrenalectomy due to HCC metastases is rather a rare procedure. This case report shows clearly the key role of careful dispensary, launched soon after the operation.

Key words:
hepatocellular carcinoma – extrahepatic metastasis – bilateral adrenalectomy

Zdroje

1. Lee JM, Park KM, Lee SY et al. Metastasis of hepatocellular carcinoma to the ovary: a case report and review of the literature.Gut Liver 2011; 5(4): 543–547.

2. Ahn SM, Jung MY, Choi HS et al. Adrenal Metastasis from Hepatocellular Carcinoma without Intrahepatic Recurrence after Hepatic Resection. Korean J Gastroenterol 2012; 59(4): 308–312.

3. Taniai N, Egami K, Wada M et al. Adrenal metastasis from hepatocellular carcinoma (HCC): report of 3 cases. Hepatogastroenterology 1999; 46(28): 2523–2528.

4. Uenishi T, Yamazaki O, Matsuyama M et al. Surgical management of bilateral adrenal metastases from hepatocellular carcinoma after transcatheter arterial embolization. Osaka City Med J 2005; 51(2): 89–93.

5. Kondo K, Chijiiwa K, Nagano M et al. Two-stage operation for hepatocellular carcinoma with synchronous bilateral adrenal gland metastasis. J Hepatobiliary Pancreat Surg 2008; 15(2): 232–236.

6. Morimoto T, Honda G, Oh Y et al. Management of adrenal metastasis of hepatocellular carcinoma by asynchronous resection of bilateral adrenal glands. J Gastroenterol 1999; 34(1): 132–137.

7. Muth A, Persson F, Jansson S et al. Prognostic factors for survival after surgery for adrenal metastasis. Eur J Surg Oncol 2010; 36(7): 699–704.

8. Procházka V, Kala Z, Jíra M et al. Laparoskopická adrenalektomie – indikace a selekční kritéria. Rozh Chir 2012; 91(4): 230–234.

9. Villar del Moral JM, Rodríguez González JM, Moreno Llorente P et al. Adrenal surgery in Spain: final results of a national survey. Cir Esp 2011; 89(10): 663–669.

10. Zonca P, Cambal M, Labas P et al. Retroperitoneoskopická adrenalektomie dorzálním přístupem. Rozh Chir 2012; 91: 235–240.

11. Alberda WJ, van Eijck CH, Feelders RA et al. Endoscopic bilateral adrenalectomy in patients with ectopic Cushing's syndrome. Surg Endosc 2012; 26(4): 1140–1145.

12. Takata MC, Kebebew E, Clark OH et al. Laparoscopic bilateral adrenalectomy: results for 30 consecutive cases. Surg Endosc 2008; 22(1): 202–207.

13. Crenn G, Delaunay B, Salloum A et al. Carcinological results of laparoscopic adrenalectomy for adrenal metastasis. Prog Urol 2011; 21(9): 607–614.

14. Adler JT, Mack E, Chen H. Equal oncologic results for laparoscopic and open resection of adrenal metastases. J Surg Res 2007; 140(2): 159–164.