Unilateral adrenal metastases as an unusual primary presentation of hepatocellular carcinoma: a case report and literature review

Abstract

Introduction and importance: Adrenal metastases can rarely present as a solitary clinical manifestation among cases with underlying hepatocellular carcinoma (HCC). Case presentation: We present the case of a 53-year-old male with chronic liver disease due to chronic hepatitis C who presented with left flank pain. Imaging revealed a left-sided suprarenal mass. Following multidisciplinary assessment, the patient underwent left-sided nephrectomy and adrenalectomy, whereas histopathological correlation revealed microscopic foci of metastatic HCC in the resected gland. Post-operative abdominal imaging then revealed multifocal dysplastic lesions scattered through both the hepatic lobes. Subsequently, systemic treatment was initiated with sorafenib. Clinical discussion: These types of adrenal metastasis from the liver are extremely uncommon and need detailed evaluation of the liver and other potential metastatic sites. The choice of treatment will be indicated according to the type and site of the tumor. Conclusion: This case highlights the significance of thorough evaluation and individualized management in HCC-associated adrenal metastasis.