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

Mohamed Abdel Wahab; Ahmed Shehta; Eman M Ibrahim; Rehab T Eldesoky; Ahmed A Sultan; Khaled R Zalata; Omar Fathy; Mohamed Elshoubary; Tarek Salah; Amr M Yassen; Mohamed Elmorshedi; Ahmed Monier; Ahmed Farouk; Usama Shiha

doi:10.1016/j.ijscr.2018.11.062

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

Int J Surg Case Rep. 2019:54:23-27. doi: 10.1016/j.ijscr.2018.11.062. Epub 2018 Nov 27.

Authors

Affiliations

¹ Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt.
² Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt. Electronic address: ahmedshehta@mans.edu.eg.
³ Department of Pathology, College of Medicine, Mansoura University, Egypt.
⁴ Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt.
⁵ Diagnostic & Interventional Radiology Department, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt.

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.

Keywords: Adrenalectomy; Direct-acting antiviral agents; Hepatocellular carcinoma recurrence; Living donor liver transplantation.