A PATIENT WITH HEPATOCELLULAR-CARCINOMA WHO UNDERWENT RESECTION OF THE PRIMARY LESION 10 YEARS AGO AND RESECTION OF A GIANT ADRENAL METASTASIS 8 AND A HALF YEARS LATER

A 56-year-old male consulted us because of a palpable mass and pain of the left flank 8 and a half years after resection of hepatocellular c arcinoma of the left lobe about 3 cm in diameter. Ultrasound examinati on of the abdomen demonstrated a tumor about 10 cm in diameter showing a mosaic of hyperechoic and hypoechoic areas on the upper pole of the left kidney. By angiography, the tumor was found to be supplied mainl y by the inferior adrenal artery. PIVKA-II was increased. Adrenal meta stasis of hepatocellular carcinoma was suspected, and adrenalectomy wa s carried out. No intrahepatic metastasis was noted. The tumor was his topathologically identified as a pseudo-glandular type of moderately d ifferentiated hepatocellular carcinoma with a trabecular pattern simil ar to the primary lesion. In this patient, a resectable giant metastas is was observed only in the left adrenal gland and no intrahepatic met astasis was demonstrated 8 and a half years after resection of hepatoc ellular carcinoma. The patient has survived 10 years after the first o peration. This case is considered to be important for evaluation of th e treatment for distant metastasis of hepatocellular carcinoma.