Surgical resection of a solitary para-aortic lymph node metastasis from hepatocellular carcinoma.
Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced computed tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.
Department of Surgery, Nippon Medical School, Tokyo 113-8603, Japan. junji0821@nms.ac.jp
Junji
J
Ueda
Hiroshi
H
Yoshida
Yasuhiro
Y
Mamada
Nobuhiko
N
Taniai
Sho
S
Mineta
Masato
M
Yoshioka
Youichi
Y
Kawano
Tetsuya
T
Shimizu
Etsuko
E
Hara
Chiaki
C
Kawamoto
Keiko
K
Kaneko
Eiji
E
Uchida
D000368:Aged; D001011:Aorta; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D011877:Radionuclide Imaging