Pedunculated HCC or adrenal metastasis: a diagnostic conundrum

Area of Science:

• Hepatology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Hepatocellular carcinoma (HCC) is the most common primary liver cancer.
• Recurrences of HCC often occur within the liver but can also present as extrahepatic metastases.
• The adrenal glands are a common site for HCC metastasis.

Observation:

• Right adrenal metastases from HCC can be mistaken for exophytic HCC arising from the liver's posterior surface.
• A case is presented of a 52-year-old man with recurrent HCC initially appearing as a posterior liver lesion, later confirmed as a right adrenal metastasis.
• Diagnostic imaging may not definitively differentiate between intrahepatic recurrence and adrenal metastasis.

Findings:

• The distinction between primary HCC and metastatic disease is clinically significant.
• Even with advanced imaging, differentiating right adrenal HCC metastasis from intrahepatic recurrence can be challenging.
• The presented case highlights the diagnostic difficulty in distinguishing these conditions.

Implications:

• Accurate differentiation is vital for appropriate treatment planning in HCC management.
• Surgical exploration and resection are often necessary for definitive diagnosis and treatment, regardless of whether the lesion is intrahepatic or metastatic.
• This underscores the importance of considering adrenal involvement in the recurrence workup of HCC patients.