Management of Bilateral Adrenal Metastases from Hepatocellular Carcinoma: A Case Report

The adrenal glands rarely are an extrahepatic site for metastasis from hepatocellular carcinoma (HCC). Once identified, adrenal metastasis requires aggressive management, due to the risk of rupture and internal hemorrhaging. Disease management of adrenal metastasis from HCC is limited, given the relative lack of available knowledge, and the present report details our efforts in managing bilateral adrenal metastases from HCC. For this patient, we used radiation therapy and transcatheter arterial chemoembolization (TACE). The left adrenal tumor was treated by 3D conformal radiation therapy, following the failure of TACE. The size of the left adrenal tumor decreased and no evidence of recurrence after management was noted. One right adrenal tumor was treated using two sessions of TACE, and the size of the tumor did not decrease. We later observed that the right tumor actually progressively increased in size. The tumor was then treated by 3D conformal radiation therapy (total 5,400 cGy), and the size decreased by 10 mm, 1 month after treatment. The patient's condition was stable and liver function was maintained at early stage liver cirrhosis (Child A). Renal function was maintained within normal ranges after diagnosis of HCC and throughout the entire follow-up period, and no complications secondary to radiation therapy were noted. Our experience may provide useful information in disease management for these patients.