Hepatocellular Carcinoma with Recurrent Extrahepatic Metastases: A Case of Longterm Survival

Abstract

A 61-year-old man had been followed-up for chronic hepatitis since 1982. In 1995, he was diagnosed with primary hepatocellular carcinoma (HCC) and liver cirrhosis and was admitted to our hospital with a Child-Pugh score of 6 (class A). A right hepatic arteriogram revealed two tumors: one measured 23×21 mm in size and was located in segment 6 of the liver, while the other measured 16×14 mm in size and was located in segment 4. The tumors were treated with transarterial chemoembolization (TACE) and percutaneous ethanol injection (PEI). In 1996, a new HCC in segment 8, a recurrent HCC in segment 4, and a right adrenal metastasis were detected, all of which were treated with TACE. In 1997, the right adrenal metastasis recurred, and TACE was performed again. In 1999, TACE was used to treat metastases in a lymph node along the lesser curvature of the stomach and a lymph node along the left gastric artery. In 2002, a recurrent metastatic lesion developed in the lymph node along the lesser curvature of the stomach and was subjected to TACE. In 2005, a recurrent HCC lesion, measuring 18 mm in diameter, was detected in segment 4, and radiofrequency ablation (RFA) was performed. The patient experienced repeated HCC recurrences, as well as adrenal and lymph node metastases, but received multidisciplinary treatment, including TACE, PEI, and RFA, and survived for 12 years.