Rubio E, González J, Jimenéz M, Lucena J L, Gimenez L, Martinez Arrieta F, Cuervas-Mons V, Turrión V S
Unidad de Trasplante Hepático, Hospital Universitario, Puerta de Hierro, UAM, Madrid, Spain.
Transplant Proc. 2009 Apr;41(3):1067-9. doi: 10.1016/j.transproceed.2009.02.018.
Hepatocellular carcinoma (HCC) represents one of the most common malignancies globally, accounting for nearly one million new cases per year. Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative, a solitary metastasis from such tumors offers a possibility of cure by surgical resection. The adrenal gland is an uncommon site for metastasis from primary liver tumors.
We report a liver transplantation case of HCC and hepatitis B virus in a 23-year-old man with an excellent postoperative result. However, because an increased alpha-fetoprotein was evident and complete radiologic and blood tests were performed, all of which were normal. Three years posttransplantation, a right adrenal mass was identified by CT. PAAF was performed as well as adrenalectomy for a solitary adrenal metastasis from hepatocellular carcinoma.
The patient underwent adrenalectomy for the right adrenal metastasis at 3 years following liver transplantation for HCC. He is presently alive and disease-free 24 months after adrenalectomy.
Carefully selected patients with solitary metastasis from HCC may be considered for resection.
肝细胞癌（HCC）是全球最常见的恶性肿瘤之一，每年新增病例近100万。虽然原发性肝肿瘤肝外转移的治疗基本上是姑息性的，但此类肿瘤的孤立转移灶通过手术切除有治愈的可能。肾上腺是原发性肝肿瘤转移的罕见部位。
我们报告了一名23岁男性肝细胞癌合并乙型肝炎病毒感染的肝移植病例，术后结果良好。然而，由于甲胎蛋白明显升高，进行了全面的影像学和血液检查，结果均正常。肝移植术后三年，CT检查发现右肾上腺有一肿块。进行了经皮肾上腺动脉化疗栓塞术（PAAF）以及针对肝细胞癌孤立性肾上腺转移灶的肾上腺切除术。
该患者因肝细胞癌肝移植术后三年出现右肾上腺转移而行肾上腺切除术。目前，他在肾上腺切除术后24个月仍存活且无疾病。
对于精心挑选的肝细胞癌孤立转移患者，可考虑行切除术。
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