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Abdominal computed tomography before liver transplantation showing large left hemi-liver hepatocellular carcinoma with partial lipidol uptake and other smaller ones in both hemi-livers.
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HCC 4.8 * 5.8 cm with partial lipidol uptake with residual viable tumor tissue, and other smaller HCCs in both hemi-livers with no lipidol uptake, and mild enlarged spleen (Fig. 1). His preoperative Child-Pugh score was 6 (class A), model for end stage liver disease (MELD) was 9, and alpha feto-protein was 14.1 ng/ml.
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Abdominal computed tomography 5 years after liver transplantation showing large left adrenal mass (white arrow).
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Triphasic CT abdomen showed normal right hemi-liver graft and its vasculature and left adrenal mass 9 cm in size suggesting metastatic HCC (Fig. 2).
Postoperative photomicrographs: (A) The neoplastic cells are arranged in thick trabeculae and nests surrounded by sinusoidal vessels. Intracellular eosinophilic hyaline bodies are frequent (Hx&E - x400). (B) Compressed adrenal gland at the periphery of the tumor (Hx&E - x200). (C) Immunohistochemistry for Hep Par-1 revealed granular cytoplasmic staining of the neoplastic cells (x400). (D) Immunohistochemistry for Glypican-3 revealed granular cytoplasmic staining of the neoplastic cells (x400).
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The tumor cells exhibit moderate degree of anaplasia (Fig. 3). Metastatic HCC was confirmed (Fig. 3).
Abdominal computed tomography 6 month after excision of metastatic adrenal hepatocellular carcinoma.
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