title: Pedunculated HCC or adrenal metastasis: a diagnostic conundrum.
abstract: Hepatocellular carcinoma (HCC) is the commonest primary liver tumour. Recurrences are common in the liver although extrahepatic metastases can occur and frequently involve the adrenals. When this occurs in the right adrenal gland, it can be confused with an exophytic HCC arising from the posterior surface of the liver. The distinction between a primary HCC and a metastasis is important but can be difficult in this clinical setting. We report a 52-year-old man with recurrent HCC presenting as an "exophytic" posterior liver surface lesion that was actually a right adrenal metastasis. Although right-sided adrenal metastases of HCC can be difficult to distinguish from intrahepatic recurrences, even with modern diagnostic imaging, management either way involves surgical exploration and resection whenever possible.
authors.affiliation: Department of Surgery, Singapore General Hospital, 1 Hospital Drive, Singapore 169608.
authors.forename: A S
authors.initials: AS
authors.lastname: M Mashfiqul
authors.forename: Y M
authors.initials: YM
authors.lastname: Tan
authors.forename: C H
authors.initials: CH
authors.lastname: Thng
authors.forename: P C
authors.initials: PC
authors.lastname: Cheow
authors.forename: Y F
authors.initials: YF
authors.lastname: Chung
authors.forename: P K
authors.initials: PK
authors.lastname: Chow
authors.forename: L L P J
authors.initials: LL
authors.lastname: Ooi
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000601:surgery; D014463:Ultrasonography