title: Adrenal metastasis as first presentation of hepatocellular carcinoma.
abstract: BACKGROUND
  Metastases from hepatocellular carcinoma (HCC) can be found in the lung and adrenal gland. We report case of a patient who presented with adrenal metastasis as the first clinical manifestation of HCC.
  
  
  METHODS
  A patient was referred for surgical treatment for a tumor in retro-peritoneal space. The computerized tomography (CT) scan revealed a mass originating from the left adrenal gland. The patient underwent left adrenalectomy and the exploration of abdominal cavity did not reveal any other palpable lesions. Histologically, the resected lesion was a poorly differentiated metastatic tumor from HCC. Seven months later patient was readmitted complaining of cachexia, icterus, and significant weight loss. CT scan revealed hyperdense lesions of the liver.
  
  
  CONCLUSIONS
  HCC may have atypical presentations like in present case. Fine needle aspiration/tru-cut biopsy might be useful in the investigation of an accidentally discovered adrenal mass regardless of the size and can lead to the detection of a primary tumor.
authors.affiliation: 4th Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou General Regional Hospital, Exohi, Thessaloniki 57010, Greece. Ctsalis@med.auth.gr
authors.forename: Kostas
authors.initials: K
authors.lastname: Tsalis
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Zacharakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Sapidis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Lambrou
authors.forename: Evangelos
authors.initials: E
authors.lastname: Zacharakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Betsis