Laparoscopic adrenalectomy for the adrenal gland metastasis from hepatocellular carcinoma

We present a case of a 70-year-old man with an anamnesis of intra-cerebral bleeding that resulted in right half of the body paralysis and right diaphragm paralysis, The present clinical history indicated hepatocellular carcinoma (HCC) caused by hepatitis C and liver cirrhosis during a regular hospital visit, and the patient had a total of 4 TAEs enforced from three years before. A 4 x 3.5 cm neoplasm at the left adrenal was detected by CT inspection this time. The diagnosis was a metastatic adrenal gland tumor from HCC. Since HCC is controlled by TAE, the metastatic lesions were not found in other organs and were isolated, of 10 cm or less in size. Hence, laparoscopic adrenalectomy was performed in March, 2006. He started having a meal from the 2nd day after the operation. He left the hospital on the 9th day. Pathologial diagnosis was a metastatic adrenal gland tumor from moderately differentiated hepatocellular carcinoma. When observing the adaptation standard strictly to the high-risk case, it was thought that the metastatic tumor extraction under laparoscopic surgery could become a low stress cure in consideration of QOL being useful as a local treatment for cancer.     

Case report--a patient who has survived more than 4 years with repeated resection for bilateral adrenal metastasis from hepatocellular carcinoma

We report a patient with bilateral adrenal metastasis from hepatocellular carcinoma (HCC) who has survived for a long period as a result of repeated resection. A 55-year-old male patient with C type hepatitis underwent transcatheter arterial chemo-embolization (TACE) for HCC in November 1997. There was no recurrence in the liver, but left adrenal metastasis was detected in January 1998, followed by right adrenal metastasis in November 1998. We performed surgical resection for bilateral adrenal metastasis in March 1999. The histological diagnosis was well approximately moderately differentiated hepatocellular carcinoma. A recurrence in the right adrenal gland was detected eight months later. As there was no distant metastasis, we performed re-operation in December 1999. Recurrence in the liver was detected in October 2000 and was treated by TACE. He has survived more than 4 years since the first detection of adrenal metastasis. We conclude that surgical treatment is useful for patients with adrenal metastasis who have no distant viable lesion.     

A successful case of systemic chemotherapy followed by liver resection for advanced hepatocellular carcinoma with highly vascular invasion and multiple pulmonary metastases

The prognosis for hepatocellular carcinoma with extrahepatic metastasis or vascular invasion is very poor. We treated a case successfully by combining chemotherapy and liver resection for hepatocellular carcinoma with multiple pulmonary metastases and vascular invasion. A 56-year-old man who complained of abdominal pain in his right side was transported to the hospital by ambulance. Because CT scan revealed the rupture of hepatocellular carcinoma, he underwent emergency transcatheter arterial embolization (TAE). A close examination revealed tumor thrombus in the inferior vena cava and posterior segment of the portal vein branch, with multiple pulmonary metastases. We conducted right hepatic lobectomy and removal of the inferior vena cava tumor thrombus. After the operation, pulmonary metastatic lesions gradually grew larger, so the oral administration of S-1 at 120 mg per day was started. At the end of the first course, the CT scan revealed that multiple pulmonary metastases were significantly reduced, and treatment was maintained until the end of 4 courses. A prolongation of survival could be expected by combining systemic chemotherapy and liver resection for advanced hepatocellular carcinoma such as the present case.     

Retrograde metastasis of hepatocellular carcinoma with an interesting lesion of the stomach--a case report

A 48-year-old man with hepatocellular carcinoma (HCC) showing tumor emboli in the portal vein and a typical retrograde metastasis via the portal vessels, is reported. Metastatic lesions were localized only in the veins of the lesser omentum, stomach, lower esophagus, pancreas, left hemidiaphragm and left adrenal gland, due to the hemodynamic alteration of the portal blood flow caused by liver cirrhosis and HCC. No metastatic lesion was found in the lung, Kidney, bone or intestine. As gastric metastasis Borrmann I, II, III and submusal tumor types were reported, but the present case revealed hard fold-like lesions, as it were, hard white varices.     

Successful surgical management of pulmonary and adrenal metastases from hepatocellular carcinoma.

This article reports a rare case of successful surgery for both lung and adrenal metastases after hepatic resection of hepatocellular carcinoma (HCC). A 55-year-old Japanese man with a 5-year history of chronic liver disease was admitted with an elevated serum alpha-fetoprotein (AFP) value and a liver tumour detected by ultrasonography. Hepatic angiogram showed a tumour stain with the right hepatic vein as a venous drain from the tumour. He underwent posterior-inferior subsegmentectomy of the right hepatic lobe following preoperative chemoembolization. Sixteen months after the first operation, he received pulmonary resection for a solitary metastasis in the right lung. A further 10 months later, a metastatic tumour was detected in the left adrenal gland without any recurrent or metastatic foci, and he underwent left adrenalectomy as his third operation. He is still alive, 8 months after his last operation, and 34 months after hepatic resection, with a normal value of AFP and without any recurrent or metastatic foci. This may be the first report of a patient who underwent successful surgery for pulmonary and adrenal metastases of HCC.     

The case of a person who was revealed by adrenal metastasis of pulmonary pleomorphic carcinoma

We report a case of fifties man. He admitted to our hospital due to a hypochondralgia. Computed tomography revealed a tumor of right adrenal gland and a tumor of upper lobe of the right lung. Adrenal tumor had rapidly increased, so we performed adrenectomy. At first adrenal tumor was diagnosed as primary adrenal cancer because its histological findings did not coincide with those of common histologic types of lung cancer. As there were possibilities that one of adrenal or lung tumor was primary and the other was metastatic or both of the two were double primary, we performed right upper lobectomy. Lung tumor was diagnosed as primary pleomorphic carcinoma containing spindle-shaped tumor cells and adenocarcinoma, and then the diagnosis of adrenal tumor was corrected as metastasis of lung cancer. Two months after the lung operation, cervical lymph node swelling, metastasis of stomach and local recurrence of adrenal tumor appeared. After he underwent six courses of systemic chemotherapy of carboplatin and paclitaxel, a clinical complete response was obtained and no recurrence is observed for 4 years.     

A case of giant hepatocellular carcinoma treatable with radio frequent ablation therapy after effective UFT administration

A 71-year-old man was diagnosed with giant hepatocellular carcinoma (HCC) and hepatitis C cirrhosis at a nearby hospital. Image diagnosis showed no other metastasis, but the tumor was very huge with daughter nodules in the bilateral lobe of the liver. He was thus treated by oral administration of UFT (300 mg/day). Two months later, the giant liver tumor had shrunk remarkably, and the daughter tumors had disappeared. Eight months later, the levels of serum AFP and PIVKA-II had also reduced remarkably. Twelve months following the first treatment, the levels of both serum AFP and PIVKA-II began increasing again, and he was referred to our hospital. CT showed 2 liver tumors, 1 of which showed viability with moderately differentiated hepatocellular carcinoma and the other evidencing necrosis histologically. Radio frequency ablation therapy was performed for 2 tumors by open laparotomy. It was considered that administration of UFT is a useful and safe therapy for far advanced HCC.     

Solitary adrenal metastasis from hepatocellular carcinoma: a case report of simultaneous successful resections

The case is presented of a 64-year-old male with a left adrenal mass and multiple liver lesions. Preoperative image work-ups included ultrasonography, computed tomography, selective liver and adrenal angiographies, and magnetic resonance imaging. Serial serum alpha-fetoprotein monitoring and the adrenal hormone profile were within the normal ranges. A left adrenalectomy and a right lobectomy of the liver were performed, and the pathology revealed hepatocellular carcinoma with left adrenal metastasis. The clinical significance of the present case, together with the diagnosis and management of the disease is discussed.     

A successful surgical treatment for solitary pulmonary and adrenal metastases after hepatic resection to hepatocellular carcinoma--a case report

We report a 65-year-old man who received a successful surgical treatment for both pulmonary and adrenal metastases after curative resection to hepatocellular carcinoma (HCC). He received a partial hepatic resection for HCC of the right hepatic lobe. Thirty-eight months after the first hepatic resection, a metastatic lesion of the right pulmonary lobe was detected by computed tomography (CT). He was orally administered of UFT (600 mg/day). After 6 months of the chemotherapy, a metastatic lesion of lung became decreased in size. However, a metastatic lesion of the right adrenal gland was detected by abdominal CT scan. Fifty six months after the first operation, we performed right adrenalectomy. A further 4 months later, we performed partial resection of the right pulmonary lobe. Eight months after the pulmonary resection, intrahepatic recurrence was detected and he received transcatheter arterial embolization (TAE) twice. Eighty one months after the first operation, he died of liver failure due to tumor progression. Surgical resection for metastases from HCC resulted in long-term survival even if there were extrahepatic metastases in two different sites.     

转移性肾上腺癌的临床治疗（附15例报告）

目的:分析我院收治的15例肾上腺转移性恶性肿瘤的临床资料，结合文献复习，总结临床诊治体会。方法:回顾性分析我院2011年1月至2019年5月收治的15例肾上腺转移性恶性肿瘤患者的临床资料。男12例，女3例；平均年龄为63岁(53～73岁)。肾上腺转移瘤的最大径中位值为4.4 cm（2.0~9.8 cm），左侧11例，右侧3例，双侧1例。原发恶性肿瘤来源:肺7例，肝3例，肾2例，子宫1例，胰腺1例，腹膜后肿物1例。本研究中15例肾上腺转移恶性肿瘤为原发肿瘤确诊后诊断，距离原发肿瘤诊断的中位时间为15.6个月(5~28个月)。15例患者均行手术切除治疗。结果:术后病理细胞类型:腺癌4例，肝细胞癌3例，透明细胞癌2例，弥漫性大B细胞瘤2例，神经内分泌癌1例，癌肉瘤1例，肺小细胞癌1例，肺大细胞癌1例。术后定期随访患者，15例患者生存4~78个月。患者最终死于肿瘤广泛转移。结论:我院肾上腺转移性恶性肿瘤的原发肿瘤以肺癌最为常见，多数转移瘤在定期复查中无意发现。我院肾上腺转移瘤以左侧多见。肾上腺转移瘤治疗方式有手术治疗、介入治疗、经皮肿瘤消融、免疫治疗、放疗和化疗等。     

A case of left urothelial carcinoma with multiple bone metastasis, liver metastasis and right adrenal metastasis successfully treated with combination chemotherapy of gemcitabine and carboplatin

The patient was a 53-year-old male. He had been admitted to another hospital with a complaint of left sciatica. He was referred to our hospital for further examination and therapy. He was diagnosed as left urothelial carcinoma with multiple bone metastasis, liver metastasis and right adrenal metastasis. He was treated with combination chemotherapy of gemcitabine and carboplatin (1,000 mg/m2 day 1 and AUC 2 day 1, respectively) biweekly. After the ninth course, a significant tumor reduction was obtained, and has been maintained. He has been treated on an outpatient basis because of no grade 3 or severer adverse reactions. We report an effective case of biweekly chemotherapy with gemcitabine and carboplatin in the treatment of advanced urothelial carcinoma.     

Complete response of a massive hepatocellular carcinoma with lung metastasis to UFT (DPD inhibitory fluoroprymidines: DIF)

A 77-year-old man was referred to our hospital because a periodic examination for hepatitis C cirrhosis and diabetes mellitus at a nearby clinic had revealed an elevated AFP level. Abdominal ultrasound and CT scan revealed a giant tumor in the right hepatic lobe, and a diagnosis of hepatocellular carcinoma was made with a biopsy. A pulmonary CT scan also revealed a diffuse granular shadow in the right lung field, leading to a diagnosis of multiple pulmonary metastases from the hepatocellular carcinoma. Arterial infusion chemotherapy was performed, but was ineffective. Thus, the administration of 600 mg/day of UFT was initiated. Both the AFP and PIVKA-2 levels, which had been increasing, returned to normal 3 months later. Ultrasound and CT scan showed that the hepatocellular carcinoma and lung metastatic foci had disappeared completely. The administration of UFT therefore appears promising for the treatment of hepatocelluar carcinoma and can be used safely, even with patients in poor general condition.     

Painless acute pancreatitis associated with sorafenib treatment: a case report

Sorafenib is a multikinase inhibitor that is used for the treatment of metastatic renal-cell carcinoma. We report the case of a patient with painless acute pancreatitis associated with sorafenib treatment. The patient was a 71-year-old man who had undergone surgery for left renal carcinoma and tumor thrombus in the inferior vena cava and right atrium (IVC-RA). After a follow-up period of 3 years, he developed right adrenal metastasis and received interferon (IFN)-alpha treatment. One year later, progression of the adrenal metastasis was observed, and he was admitted to a hospital for treatment with sorafenib, which was administered at a dose of 800 mg/day. Two weeks later, he developed painless acute pancreatitis associated with sorafenib treatment. Thereafter, sorafenib treatment was discontinued, and he was treated with conservative therapy. Three weeks later, he was discharged. Even though painless acute pancreatitis associated with sorafenib treatment is rare, the possible development of painless acute pancreatitis in patients undergoing sorafenib treatment must be kept in mind.     

Radiation therapy for adrenal gland metastases from hepatocellular carcinoma

BACKGROUND: The adrenal gland is a common site of extrahepatic metastases from hepatocellular carcinoma. However, it has been the subject of few studies, and the optimal treatment remains unclear. Methods previously tried for the management of adrenal gland metastasis of hepatocellular carcinoma included surgical resection, transarterial chemoembolization or percutaneous ethanol injection, on the basis of case reports. External beam radiation therapy has seldom been applied for patients with adrenal gland metastases. METHODS: We retrospectively studied 22 patients with adrenal metastases from hepatocellular carcinoma who were treated with limited-field external beam radiation therapy. The radiation dose to the adrenal lesion ranged from 36 to 54 (median 50) Gy, while the intrahepatic lesions were treated with either surgical resection or transarterial chemoembolization. RESULTS: Among the 14 patients who had pain related to adrenal metastases, 11 (78.6%) had complete pain relief without medication that lasted until death. Two (14.3%) patients had marked pain relief, but still required analgesics. Partial responses were observed in 73% of the patients. The median survival period for all patients was 10 months. No patient died from complications related to adrenal metastasis. Adverse effects were mild. CONCLUSION: Adrenal metastases from hepatocellular carcinoma are sensitive to radiation treatment. Radiation therapy with 50 Gy for adrenal gland metastases is a good palliative therapy with reasonable safety.     

A case of brain metastasis from hepatocellular carcinoma

Reported is the case of a patient who underwent surgical resection of a brain metastasis from a hepatocellular carcinoma. The 62-year-old male was admitted to hospital because of headaches and a left hemiparesis. Six years earlier he had undergone transcatheter arterial embolization for a hepatocellular carcinoma. Further, one year ago the lower lobe of his right lung had been resected because of a pulmonary metastasis from the same tumor. A neurological examination on admission revealed disorientation, dressing apraxia, and a left hemiparesis. A CT scan revealed two highly dense masses with peripheral low dense areas in the right temporoparietal region, which were heterogenously enhanced with a contrast medium. Right carotid angiogram showed tumor stains in the same region. Also, a magnetic resonance T1 weighted image showed highly intense masses, and a T2 weighted image showed low intensity masses with prominent brain edema. Thus, a right fronto-temporo-parietal craniotomy was performed, and the two masses were removed. Histological examination revealed hepatocellular carcinoma. The postoperative course was uneventful, and the left hemiparesis improved gradually, enabling the patient to walk without assistance. A brain metastasis from a hepatocellular carcinoma has been rarely reported in the literature since the survival period is very short due to rapid disease progression at the primary site, so that most reports have been based on postmortem examination. The MRI, CT, and the angiographic findings are included in this report.     

Hepatocellular carcinoma presenting with bone metastasis

Bone metastasis is an unusual complication of hepatocellular carcinoma. We report here 2 cases of patients with bone metastases of hepatocellular carcinoma at presentation. Patient No. 1 with liver cirrhosis and hepatocellular carcinoma was admitted with a bone metastasis in the rib. The patient was treated with hepatic arterial chemotherapy and rib resection. Patient No.2 was known to have an asymptomatic liver mass of uncertain histology for a year when he presented with back pain. Because of signs of spinal compression, laminectomy was performed, and the diagnosis of metastatic hepatocellular carcinoma was established. The presence of bone metastases in hepatocellular carcinoma at presentation is extremely rare. More frequently, bone lesions are observed after successful treatment of the primary liver tumor. Both surgery and radiotherapy are used as palliative treatment in bone metastases of hepatocellular carcinoma. The treatment of hepatocellular carcinoma presenting with bone metastasis by bone resection and intraarterial chemotherapy seems to be of limited impact on patient survival because of dissemination of micrometastases in other organs and the frequent presence of other comorbid conditions. However, effective palliation using this multimodality approach is feasible. Hepatocellular carcinoma should be considered in the differential diagnosis of bone metastases.     

肝细胞肝癌肾上腺转移的放射治疗

目的探讨肝癌肾上腺转移的放射治疗效果.方法回顾性总结本院22例肝癌肾上腺转移病人,用6MX或15MV光子,进行肾上腺病灶外照射,剂量36～54Gy,中位剂量50Gy.结果14例肾上腺转移病人出现疼痛症状,外放疗后11例(78.6%)疼痛得到完全缓解;2例(14.3%)得到明显缓解,但仍需要止痛药治疗;73%(15/22)病例的肿瘤明显缩小;全部病例中位生存期为10个月;未出现因肾上腺转移灶致死病例;副作用轻微.结论肝细胞肝癌肾上腺转移对放射治疗敏感,50Gy的放疗剂量是比较安全的姑息性治疗.     

Multidisciplinary treatment for advanced hepatocellular carcinoma with portal vein tumor thrombosis and adrenal/lung metastases

The patient was a 73-year-old male who was identified with an increase of serum PIVKA-II during a treatment for chronic hepatitis B. Hepatocellular carcinoma (HCC) of 60 mm in diameter with satellite nodules was diagnosed in segment 8 of the liver. In addition, portal vein tumor thrombosis (PVTT) of the right branch (Vp3) and metastases to bilateral lung and right adrenal gland were recognized. He received serial treatments with transcatheter arterial chemoembolization (TACE), radiation therapy and hepatic arterial chemotherapy with reservoir for primary liver tumor and PVTT. Soon after the treatments, PVTT was reduced in size and the serum level of PIVKA-II was decreased to 57 mAU/ml. After three months, the level of PIVKA-II had increased again and the size of the right adrenal metastasis grew to 50 mm in diameter. He received TACE to the right adrenal metastasis and percutaneous transhepatic portal chemoembolization to prevent further growth of PVTT. In spite of several treatments, the therapeutic effect was insufficient. Therefore, we performed right adrenalectomy and radio-frequency ablation of HCC in the liver S8. After the surgery, he received two times of TACE and the viable tumor had disappeared on CT and MRI. Prognosis of HCC with PVTT and distant metastasis is very poor. The two-year survival rate is less than 10%. However, it is possible to improve the prognosis of advanced HCC by multidisciplinary treatment with surgical intervention, local chemotherapy and radiation therapy.     

A case of long-term survival after resection for postoperative solitary adrenal metastasis from esophageal adenocarcinoma

A 71-year-old man presented with chief complains of hoarseness and dysphagia. He was diagnosed to have an advanced esophageal adenocarcinoma in the middle thoracic esophagus for which chemoradiation therapy was started. Partial response was observed and he was referred to our hospital thereafter. After detailed examination, he underwent a subtotal esophagectomy followed by two-field lymphadenectomy in May 2001. Histopathological examination revealed a complete response. Ten months later, hematological examination showed a high serum CEA level and CT scan disclosed mediastinal lymph node recurrences. He received a course of systemic chemotherapy so called FP therapy and five months later, a course of combination chemotherapy with 700 mg/m2 5-FU on days 1-5 and 70 mg/m2 nedaplatin on day 1 was administered. Because the high serum CEA level sustained afterward, FDG-PET was undertaken in March 2003. The right adrenal gland showed an intense abnormal FDG uptake and CT scan detected a low density mass in the area. Since no metastases could be identified in other sites, right adrenalectomy was performed. Pathological finding was poorly-differentiated tubular adenocarcinoma. Five years and eleven months after adrenalectomy, he died of pneumonia with no signs of recurrence. Surgical resection may contribute to improving the prognosis of solitary adrenal metastasis of esophageal cancer without the other noncurative factors.     

A Case of Hepatocellular Carcinoma Developed on Polycystic Disease of the Liver with Cirrhosis

A case of hepatocellular carcinoma associated with polycysticdisease of the liver and posthepatitic cirrhosis in a 56-year-oldKorean woman was described. She was first admitted because ofepigastralgia, irradiated back pain and general fatigue. Onthe liver scan a relative cold area was demonstrated. The celiacangiography revealed multiple avascular areas indicating cysticlesions. The exploratory laparotomy confirmed the presence ofpolycystic disease of the liver with cirrhosis. Four years afterthe first admission, she underwent an appendectomy. At the timeof operation, the surgeon suspected the presence of hepatocellularcarcinoma, and she was admitted for the second time to our hospital.The minimal elevation of serum -fetoprotein was observed. Thedevelopment of hepatocellular carcinoma was confirmed by theceliac angio graphy, and a partial lobectomy of the liver wasperformed. Four months after the operation she died of hepaticfailure. Of the four reported cases of hepatocellular carcinoma associatedwith polycystic disease of the liver including this case, allhad liver cirrhosis, and serum HBs-Ag was positive in all ofthe three cases examined.