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Chirurgia 2012 April;25(2):135-9

language: English

Surgical treatment for bilateral adrenal metastases from hepatocellular carcinoma: report of 2 cases and review of the literature

Hayashi M. 1, Shimizu T. 1, Inoue Y. 1, Komeda K.1, Asakuma M. 1, Hirokawa F. 1, Miyamoto Y. 1, Takeshita A. 2

1 Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan;
2 Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan


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Although short-term survival outcomes of hepatocellular carcinoma (HCC) have been improved dramatically in recent years, the optimal management of distant metastatic lesions from HCC has not yet been established, thus resulting in poor long-term prognosis. Regarding adrenal glands, the most frequent metastatic sites from HCC, there have been no definitive treatment guidelines when metastasis occurs. We herein describe two cases of successful resection of bilateral adrenal metastases from HCC. Case 1: A 53-year-old man with liver cirrhosis associated with hepatitis B viral infection received right hepatectomy for HCCs, and on follow-up six months after the operation, left adrenal metastasis was observed, which was treated by adrenalectomy. Two years after the second operation, right adrenal metastasis was discovered, for which right adrenalectomy combined with partial resection of the inferior vena cava (IVC) wall was performed. Case 2: A 73-year-old man with liver cirrhosis associated with hepatitis C viral infection was found to have two HCCs, both of which could be treated and well controlled by repeated local ablation therapy. On the follow-up, he was found to have bilateral adrenal metastasis. Since the right adrenal metastatic lesion increased in size, with tumor thrombus emerging into the IVC through the right adrenal vein, right adrenalectomy and removal of tumor thrombus in the IVC was performed. The left adrenal metastasis was treated conservatively by repeated transcatheter arterial chemo-embolization, but the tumor size increased gradually despite therapy; therefore, left adrenalectomy was performed. In both cases, immediately after second adrenalectomy, hydrocortisone supplementation was initiated, hereby no symptoms suggesting adrenal insufficiency being recognized. It is suggested that surgical resection is the most beneficial option for treating bilateral adrenal metastases from HCC.

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