Abstract
BackgroundThe most common sites of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been reported to be the liver, lung, bone, and adrenal glands, but there have also been many reports of cases of multiple recurrence. The prognosis after recurrence is poor, with reported median survival after recurrence of HCC ranging from 9 to 19 months. Here, we report a case of long-term survival after recurrence of pharyngeal metastasis following living-donor liver transplantation (LDLT) for HCC within the Milan criteria, by resection of the metastatic region and cervical lymph node dissection.Case presentationA 47-year-old man with a Model End-stage Liver Disease (MELD) score of 11 underwent LDLT for HCC within the Milan criteria for liver cirrhosis associated with hepatitis B virus infection, with his 48-year-old elder brother as the living donor. One year and 10 months after liver transplantation, he visited a nearby hospital with a chief complaint of discomfort on swallowing. A pedunculated polyp was found in the hypopharynx, and biopsy revealed HCC metastasis. We performed pharyngeal polypectomy. Two years later, cervical lymph node metastasis appeared, and neck lymph node dissection was performed. Although recurrence subsequently occurred three times in the grafted liver, the patient is still alive 12 years and 10 months after recurrence of pharyngeal metastasis. He is now a tumor-free outpatient taking sorafenib.ConclusionIt is necessary to recognize that the nasopharyngeal region is a potential site of HCC metastasis. Prognostic improvement can be expected with close follow-up, early detection, and multidisciplinary treatment, including radical resection.
Highlights
ConclusionIt is necessary to recognize that the nasopharyngeal region is a potential site of hepatocellular carcinoma (HCC) metastasis
The most common sites of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been reported to be the liver, lung, bone, and adrenal glands, but there have been many reports of cases of multiple recurrence
We report a case of long-term survival after resection of the pharyngeal metastasis due to HCC recurrence after living-donor liver transplantation (LDLT)
Summary
We have reported a rare case of pharyngeal metastasis following LDLT for HCC. The cervical region must be recognized as a primary site of extrahepatic metastasis of HCC via the portal–vertebral venous plexus. Even with recurrence in the pharyngeal region, patients can achieve long-term survival, as in the present case. Diagnosis of recurrence via careful periodic follow-up examinations of the cervical to nasopharyngeal region, together with frequent sites of metastatic recurrence such as the lungs, grafted liver, adrenal glands, bone, and abdominal lymph nodes, is required. There is no established immunotherapy or adjuvant chemotherapy after liver transplantation that suppresses HCC recurrence. The effectiveness of surgical treatment for the oligo-recurrence of HCC after liver transplantation has been reported, but there is no effective treatment for multiple recurrences.
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