Isolated adrenal metastasis for hepatocellular carcinoma: a case report and literature review.

Background: We report one of the few cases in the United States of an isolated contralateral adrenal gland metastasis found 2 years after resection of a primary right hepatic lobe hepatocellular carcinoma (HCC). Case Description: The patient is a 60-year-old male with chronic hepatitis B and C who was found on imaging to have a 5.5 cm mass in segment 7 of the liver. He underwent transarterial chemoembolization of the right hepatic artery while awaiting liver transplantation evaluation. After his mass decreased in size, the patient declined transplantation and pursued resection. He underwent partial hepatectomy with cholecystectomy with final pathology showing a 6.5 cm well differentiated HCC with no vascular invasion and clear margins. After completion of treatment for hepatitis B and C, his surveillance magnetic resonance imaging (MRI) 2 years later showed a 2 cm left adrenal nodule but no local recurrence. The patient declined resection and elected for serial short term interval imaging. His next MRI was 14 months later showing the left adrenal nodule had increased in size to 4 cm. He underwent a laparoscopic left adrenalectomy with final pathology consistent with metastatic HCC. Surveillance MRI 21 months after surgery showed no evidence of recurrent disease. Conclusions: In this report, we describe one of the rare cases in the United States of a patient with primary HCC who underwent liver resection and was subsequently found to have an isolated metachronous contralateral adrenal metastasis. This case highlights the need for further work in developing the optimal treatment of isolated extra-hepatic metastases and targeted systemic therapies.