Recurrent hepatocellular carcinoma presenting with superior vena cava syndrome

A 45-year-old male received wedge resection for his small hepatocellular ca rcinoma in April 1989 and extended right lobectomy for tumor recurrence 8 m onths later. Unfortunately, recurrent hepatic tumor with lung metastases we re found 18 months after the second operation. Both the hepatic and pulmona ry recurrent tumors were resected and transcatheter arterial embolization w as added for the residual hepatic tumors. He remained symptom free for anot her 18 months. However, mediastinal lymphadenopathy, superior vena cava thr ombus with superior vena cava syndrome, cardiac and brain metastases develo ped subsequently. He died of increased intracranial pressure. It is rare fo r hepatocellular carcinoma to have mediastinal metastases, superior vena ca va thrombus and superior vena cava syndrome.