Adrenalectomy for solitary recurrent hepatocellular carcinoma five years after living donor liver transplantation: A case report. (2019)

• Record Type: Journal Article
• Authors: Abdel Wahab, Mohamed; Shehta, Ahmed; Ibrahim, Eman M.; Eldesoky, Rehab T.; Sultan, Ahmed A.; Zalata, Khaled R.; Fathy, Omar; Elshoubary, Mohamed; Salah, Tarek; Yassen, Amr M.; Elmorshedi, Mohamed; Monier, Ahmed; Farouk, Ahmed; Shiha, Usama
• Is Part Of: International journal of surgery case reports. Volume 54(2019)
• Page Start: 23
• Page End: 27
• Publication Date: 2019
• Subjects: HCC hepatocellular carcinoma -- HCV hepatitis C virus -- LDLT living-donor liver transplantation -- CT computed tomography -- MELD model for end stage liver disease -- GRWR graft to recipient weight ratio -- US ultrasound -- SVR sustainedvirologic response; Living donor liver transplantation -- Hepatocellular carcinoma recurrence -- Adrenalectomy -- Direct-acting antiviral agents; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2018.11.062
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Solitary adrenal recurrence of HCC after LDLT is extremely rare. Strict follow up protocol is necessary to allow early detection of tumor recurrence. Curative surgical resection of solitary recurrent HCC is a safe option. It is associated with low morbidity and expected to have a good long-term survival. Abstract: Introduction: The adrenal gland is a rare site for hepatocellular carcinoma (HCC) recurrence after living-donor liver transplantation (LDLT). Solitary adrenal recurrence can be managed by surgical excision, with expected better survival outcomes. We describe a rare case of successful left adrenalectomy of solitary recurrent HCC in the left adrenal gland 5 years after LDLT. Presentation: 59 years male patient with HCC complicating chronic HCV infection received a right hemi-liver graft from his son. The actual graft weight was 1208 g and GRWR was 1.5. The patient started oral direct acting antiviral drugs for recurrent HCV 2 years after LDLT. A left adrenal mass was detected on follow up radiology. No other metastatic lesions were detected on metastatic workup. Left adrenalectomy was done by an anterior approach. The postoperative course was uneventful and was discharged a week after operation. Postoperative pathological and immune-histochemical examinations confirmed the metastatic HCC nature of the mass. The patient is under regular follow up with no recurrences 6 month after resection. Discussion: There is no consensus regarding the management of HCC recurrence after LDLT. Most patients had multi-organ recurrences and usually offered palliative or supportive care. Solitary HCC recurrence offers a better chance for more aggressive therapy, offering better prognosis. Conclusion: Solitary adrenal recurrence of HCC after LDLT is extremely rare. Strict follow up protocol is necessary to allow early detection of tumor recurrence. Curative surgical resection is a safe option associated with low morbidity and expected to have a good long-term survival.