Surgical management of bilateral adrenal metastases from hepatocellular carcinoma after transcatheter arterial embolization

Despite progress in therapy for hepatocellular carcinoma, management of extrahepatic metastatic lesions remains problematic. A 73-year-old man who underwent transcatheter arterial embolization for hepatocellular carcinoma presented bilateral adrenal metastases. Ten months after transcatheter arterial embolization, computed tomography detected huge tumors in both adrenal glands. Simultaneous resection of both adrenal lesions was performed under hydrocortisone replacement therapy. These tumors were confirmed histopathologically to represent adrenal metastatic lesions of hepatocellular carcinoma. The patient died of respiratory failure due to lung metastasis 9 months after adrenalectomy, although intrahepatic tumor was controlled by transcatheter arterial embolization. It is necessary to clarify the therapeutic effectiveness and the indication of adrenalectomy for patients with adrenal metastasis.