No abstract

The Adrenal gland is the second most common site of metastasis from a hepatocellular carcinoma (HCC) (1). Surgical adrenalectomy has been reported to be an effective treatment for the metastatic tumors (2, 3). However, nonsurgical treatments such as transarterial chemoembolization (TACE) or percutaneous ethanol injection therapy (PEI) have also been reported as potentially equivalent alternatives for these tumors (4). Recently, radiofrequency ablation (RFA) for these tumors has also been reported with favorable clinical results, especially for inoperable patients (5, 6). For intermediate or large adrenal tumors, however, complete necrosis of the adrenal tumors may not be achieved without difficulty. Combination therapy with transarterial chemoembolization (TACE) and RFA can be attempted for this situation. As with liver tumors, it can reduce the heat sink effect by the arterial feeders, and thus can increase the volume of the ablation. We report here a case of a 5.0 cm sized metastatic adrenal tumor from a HCC that was successfully treated with combination therapy of TACE and RFA. Case ReportA 74-year-old man presented with abdominal discomfort and a palpable abdominal mass. An abdominal CT revealed a large liver mass with a measured diameter of 7 cm. The serum alpha-fetoprotein level (AFP) was mea- The adrenal gland is the second most common site of metastasis from a hepatocellular carcinoma (HCC). Radiofrequency ablation (RFA) for these tumors has been reported to be a potentially effective alternative to an adrenalectomy, especially for inoperable patients. However, for intermediate or large adrenal tumors, combination therapy of transarterial chemoembolization (TACE) and RFA can be attempted as it may reduce the heat sink effect. A 74-year-old patient presented with abdominal discomfort. Abdominal CT images revealed a 5.0 cm sized right adrenal mass. A percutaneous biopsy of the adrenal mass revealed a metastatic hepatocellular carcinoma. TACE was performed on the adrenal mass. However, a one-month follow-up CT image revealed a residual viable tumor. RFA was performed for the adrenal tumor six weeks after the TACE. No procedure-related major complications were noted. The serum alpha-fetoprotein level had also been normalized after the treatment, and 10-month follow-up CT images showed no definite evidence of viable adrenal tumor.