Fairly rare small-diameter hepatocellular carcinoma with right adrenal gland metastasis having an inferior vena cava tumor thrombus: a case report
Abstract Background Hepatocellular carcinoma (HCC) may lead to extrahepatic metastasis (EHM). Most patients with EHM had either intrahepatic stage III or IVA tumor at the site of metastases. Herein, we present the case of a fairly rare 1.5-cm small-diameter HCC with right adrenal gland tumor having...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2019-11-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-019-0705-7 |
| _version_ | 1828779162683310080 |
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| author | Takamichi Igarashi Norifumi Harimoto Nozomi Matsumura Masaya Sugiyama Kenichiro Araki Takehiko Yokobori Takashi Kosone Hitoshi Takagi Shinichi Aishima Hideaki Yokoo Ken Shirabe |
| author_facet | Takamichi Igarashi Norifumi Harimoto Nozomi Matsumura Masaya Sugiyama Kenichiro Araki Takehiko Yokobori Takashi Kosone Hitoshi Takagi Shinichi Aishima Hideaki Yokoo Ken Shirabe |
| author_sort | Takamichi Igarashi |
| collection | DOAJ |
| description | Abstract Background Hepatocellular carcinoma (HCC) may lead to extrahepatic metastasis (EHM). Most patients with EHM had either intrahepatic stage III or IVA tumor at the site of metastases. Herein, we present the case of a fairly rare 1.5-cm small-diameter HCC with right adrenal gland tumor having an inferior vena cava (IVC) tumor thrombus. Case presentation A 75-year-old man had a 1.5-cm hepatocellular carcinoma (HCC) in segment 8 of the liver and a 3.0-cm right adrenal gland tumor with inferior vena cava (IVC) tumor thrombus. He underwent partial hepatectomy, right adrenalectomy, and IVC tumor thrombectomy. Tumor resection was successful, but the tumor progressed rapidly, and the patient died 8 months after the operation. Immunohistochemical staining revealed that both HCC cells and adrenal tumor cells were positive for HCC markers Glypican-3 and alpha-fetoprotein. In terms of adrenal carcinoma markers vimentin and Melan-A, vimentin was negative in the HCC and adrenal tumor, and Melan-A was negative in the HCC. In adrenal tumor, slight positivity of Melan-A was observed, but the intensity of staining was clearly weak compared with that in normal adrenal glands. CD133, one of the stem cell markers, was positive in both HCC and adrenal tumor cells. Next-generation amplicon sequencing analyses were performed using DNA derived from the HCC, adrenal tumor, and normal liver tissue. After exome data analyses for representative HCC-related genes as TERT, CTNNB1, TP53, and ARID2, TP53 mutation (exon3: c.G351 T: p.R117S) was found in both HCC cells and adrenal tumor cells. Conversely, no significant mutations in other genes were observed. These pathological findings and sequencing results showed that the adrenal tumor might be an adrenal metastasis of HCC in spite of small primary tumor size. Conclusions This case suggests that the right adrenal tumor was a metastasis of HCC. Immunohistochemical staining and gene mutation analyses using NGS are very useful in differentiating the tumor origin. |
| first_indexed | 2024-12-11T16:57:30Z |
| format | Article |
| id | doaj.art-02395731c33d48979d4ebedd93133d4a |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-12-11T16:57:30Z |
| publishDate | 2019-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-02395731c33d48979d4ebedd93133d4a2022-12-22T00:57:56ZengSpringerOpenSurgical Case Reports2198-77932019-11-01511610.1186/s40792-019-0705-7Fairly rare small-diameter hepatocellular carcinoma with right adrenal gland metastasis having an inferior vena cava tumor thrombus: a case reportTakamichi Igarashi0Norifumi Harimoto1Nozomi Matsumura2Masaya Sugiyama3Kenichiro Araki4Takehiko Yokobori5Takashi Kosone6Hitoshi Takagi7Shinichi Aishima8Hideaki Yokoo9Ken Shirabe10Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of MedicineDepartment of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of MedicineDepartment of Human Pathology, Gunma University Graduate School of MedicineGenome Medical Science Project, The Research Center for Hepatitis and Immunology, National Center for Global Health and MedicineDepartment of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of MedicineDepartment of Innovative Cancer Immunotherapy, Gunma University Graduate School of MedicineDepartment of Gastroenterology and Hepatology, Kusunoki HospitalDepartment of Gastroenterology and Hepatology, Kusunoki HospitalDepartment of Pathology and Microbiology, Saga University Graduate School of MedicineDepartment of Human Pathology, Gunma University Graduate School of MedicineDepartment of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of MedicineAbstract Background Hepatocellular carcinoma (HCC) may lead to extrahepatic metastasis (EHM). Most patients with EHM had either intrahepatic stage III or IVA tumor at the site of metastases. Herein, we present the case of a fairly rare 1.5-cm small-diameter HCC with right adrenal gland tumor having an inferior vena cava (IVC) tumor thrombus. Case presentation A 75-year-old man had a 1.5-cm hepatocellular carcinoma (HCC) in segment 8 of the liver and a 3.0-cm right adrenal gland tumor with inferior vena cava (IVC) tumor thrombus. He underwent partial hepatectomy, right adrenalectomy, and IVC tumor thrombectomy. Tumor resection was successful, but the tumor progressed rapidly, and the patient died 8 months after the operation. Immunohistochemical staining revealed that both HCC cells and adrenal tumor cells were positive for HCC markers Glypican-3 and alpha-fetoprotein. In terms of adrenal carcinoma markers vimentin and Melan-A, vimentin was negative in the HCC and adrenal tumor, and Melan-A was negative in the HCC. In adrenal tumor, slight positivity of Melan-A was observed, but the intensity of staining was clearly weak compared with that in normal adrenal glands. CD133, one of the stem cell markers, was positive in both HCC and adrenal tumor cells. Next-generation amplicon sequencing analyses were performed using DNA derived from the HCC, adrenal tumor, and normal liver tissue. After exome data analyses for representative HCC-related genes as TERT, CTNNB1, TP53, and ARID2, TP53 mutation (exon3: c.G351 T: p.R117S) was found in both HCC cells and adrenal tumor cells. Conversely, no significant mutations in other genes were observed. These pathological findings and sequencing results showed that the adrenal tumor might be an adrenal metastasis of HCC in spite of small primary tumor size. Conclusions This case suggests that the right adrenal tumor was a metastasis of HCC. Immunohistochemical staining and gene mutation analyses using NGS are very useful in differentiating the tumor origin.http://link.springer.com/article/10.1186/s40792-019-0705-7Hepatocellular carcinomaExtrahepatic metastasisAdrenal metastasisTumor thrombus |
| spellingShingle | Takamichi Igarashi Norifumi Harimoto Nozomi Matsumura Masaya Sugiyama Kenichiro Araki Takehiko Yokobori Takashi Kosone Hitoshi Takagi Shinichi Aishima Hideaki Yokoo Ken Shirabe Fairly rare small-diameter hepatocellular carcinoma with right adrenal gland metastasis having an inferior vena cava tumor thrombus: a case report Surgical Case Reports Hepatocellular carcinoma Extrahepatic metastasis Adrenal metastasis Tumor thrombus |
| title | Fairly rare small-diameter hepatocellular carcinoma with right adrenal gland metastasis having an inferior vena cava tumor thrombus: a case report |
| title_full | Fairly rare small-diameter hepatocellular carcinoma with right adrenal gland metastasis having an inferior vena cava tumor thrombus: a case report |
| title_fullStr | Fairly rare small-diameter hepatocellular carcinoma with right adrenal gland metastasis having an inferior vena cava tumor thrombus: a case report |
| title_full_unstemmed | Fairly rare small-diameter hepatocellular carcinoma with right adrenal gland metastasis having an inferior vena cava tumor thrombus: a case report |
| title_short | Fairly rare small-diameter hepatocellular carcinoma with right adrenal gland metastasis having an inferior vena cava tumor thrombus: a case report |
| title_sort | fairly rare small diameter hepatocellular carcinoma with right adrenal gland metastasis having an inferior vena cava tumor thrombus a case report |
| topic | Hepatocellular carcinoma Extrahepatic metastasis Adrenal metastasis Tumor thrombus |
| url | http://link.springer.com/article/10.1186/s40792-019-0705-7 |
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