T. Morimoto et al., Management of adrenal metastasis of hepatocellular carcinoma by asynchronous resection of bilateral adrenal glands, J GASTRO, 34(1), 1999, pp. 132-137
We report on a 65-year-old man who received asynchronous bilateral adrenale
ctomy for adrenal metastasis of hepatocellular carcinoma. Fifteen months af
ter curative resection of right hepatic lobe for hepatocellular carcinoma,
a metastatic lesion of the left adrenal gland was detected and left adrenal
ectomy was performed. Ten months after the second operation, a metastatic l
esion in the right adrenal gland, associated with tumor thrombus in the inf
erior vena cava. was revealed. Transcatheter arterial embolization of the a
rteries feeding the metastatic tumor was performed, but its effects were in
complete. As there was the tumor thrombus in the inferior vena cava and no
other intrahepatic recurrence or extrahepatic metastasis was found, resecti
on of the right adrenal gland with tumor thrombus, without the employment o
f veno-venous bypass. was performed, followed by postoperative hormonal sup
plementation. Changes in the patient's alpha-fetoprotein level were clinica
lly useful for the detection of the metastatic lesions and the evaluation o
f therapeutic effects. Metastasis to adrenal gland from hepatocellular carc
inoma should be actively managed, and the appropriate surgical treatment se
lected, if intrahepatic recurrence and/or other extrahepatic metastasis are
controlled. To achieve higher curability and better outcome in patients wi
th bilateral adrenal metastasis of hepatocellular carcinoma, bilateral tota
l adrenalectomy is indicated, accompanied by effective postoperative hormon
al supplementation.