Atypical Presentation of Recurrent Hepatocellular Carcinoma After Liver Transplant

Liver transplantation remains the optimal treatment modality for patients with early-stage hepatocellular carcinoma who meet criteria for transplant. With continued expansion of criteria for liver transplantation in hepatocellular carcinoma, tumor recurrence after transplant remains a major concern, with lung and bones being the most common sites of extrahepatic recurrence after liver transplant. Cardiac metastasis of hepatocellular carcinoma that is not contiguous with the primary liver lesion is extremely rare. We describe the first reported case of recurrent hepatocellular carcinoma after transplant presenting with left atrial cardiac metastasis. As was the case in our patient, prognosis of hepatocellular carcinoma with cardiac metastases is poor. This rare manifestation of advanced hepatocellular carcinoma should be considered in the differential diagnosis of patients with recurrent hepatocellular carcinoma after transplant presenting with cardiac symptoms or imaging evidence of left atrial soft tissue mass. This observation is of added relevance in the context of ongoing efforts to expand access to liver transplant for patients with hepatocellular carcinoma using immunotherapy to downstage tumors that exceed conventional criteria.