Iwamoto S, Okuda K, Takeda N, Sonoda K, Sanefuji H
Iwamoto Hospital, Department of Surgery, Kitakyushu, Japan.
J Gastroenterol Hepatol. 1997 May;12(5):392-7. doi: 10.1111/j.1440-1746.1997.tb00449.x.
The adrenal is the second most common site of haematogenous metastasis of hepatocellular carcinoma (HCC). The right adrenal is much more frequently affected than the left, but no reason has been offered for this difference. An aetiological connection has never been suggested between adrenal metastasis and pedunculated HCC. Hepatocellular carcinoma was resected in two patients who subsequently developed right-sided adrenal metastasis diagnosed by imaging. The adrenal mass was enhanced by hepatic arteriography and took up lipiodol injected into the hepatic artery. Reoperation was performed to remove the adrenal mass, which was abutting on the liver but was readily separable. Histopathologically, the adrenal gland was compressed by a metastatic HCC that developed in the immediate periadrenal tissue or adrenal capsule. By conventional imaging, the adrenal gland could not be recognized and the mass was thought to have arisen within the adrenal gland. In conclusion, periadrenal growth of HCC is a hitherto unrecognized type of metastasis and must have been mistaken either for an adrenal metastasis or a pedunculated HCC in the past. If left unresected, it would have fused with the liver and grown into a pedunculated HCC. Cancer cell invasion through an adrenohepatic fusion is the most likely mode of periadrenal metastasis; it explains the arterial communication between the mass and the liver.
肾上腺是肝细胞癌（HCC）血行转移的第二常见部位。右侧肾上腺比左侧更常受累，但尚未对这种差异给出原因。从未有人提出肾上腺转移与带蒂HCC之间存在病因学联系。两名患者接受了肝细胞癌切除术，随后经影像学诊断发生了右侧肾上腺转移。肝动脉造影显示肾上腺肿块有强化，且摄取了注入肝动脉的碘油。对紧邻肝脏但易于分离的肾上腺肿块进行了再次手术切除。组织病理学检查显示，肾上腺被肾上腺周围组织或肾上腺包膜内发生的转移性HCC压迫。通过传统影像学检查，肾上腺无法辨认，肿块被认为起源于肾上腺内。总之，HCC在肾上腺周围生长是一种迄今未被认识的转移类型，过去肯定被误诊为肾上腺转移或带蒂HCC。如果不切除，它会与肝脏融合并发展成带蒂HCC。癌细胞通过肾上腺肝融合处浸润是肾上腺周围转移最可能的方式；这解释了肿块与肝脏之间的动脉交通。
