Transplant Reports : Open Access
Open Access

Adrenal glands; Adrenal metastasis; Intrahepatic metastasis

Introduction

Liver transplant is a potentially restorative treatment for cases with hepatocellular melanoma (HCC), fulfilling specific criteria that take into account the morphology (size and number) of the excrescence, the case's functional status, and the status of the case’s liver.1 In cases named on the base of the below criteria, 5- time overall survival after liver transplant is over to 70 and 5- time complaint-free survival is close to65.

The scattered liver is the most common point of rush, and extra hepatic metastases are also generally set up during complaint progression. Adrenal glands are among the most generally affected spots along with the lungs and bones. Insulated metastatic complaint in the adrenal glands, especially bilateral, is occasional, and only infrequently are similar cases campaigners for surgical treatment. In this report, we describe a case of a case who passed left Adrenalectomy for an insulated adrenal metastasis( AM) from HCC 2 times after orthotropic liver transplant and also a right Adrenalectomy for another insulated AM 1 time latterly [1-3].

Thirty months after the orthotropic liver transplant, a control ultrasonography revealed excrescence involves- ment of the left adrenal gland. The case’s AFP position was normal, and no signs of excrescence dispersion were visible on multislice reckoned tomography reviews. Left Adrenalectomy was performed, and an11.5- cm excrescence was removed together with the adrenal gland. One time after that surgery (42 months post-transplant), the case was admitted to the exigency department at our center because of abdominal pain radiating to the right hand. A multislice reckoned tomography checkup showed a discrepancy- enhanced mass in the right adrenal gland with a girding hematoma. The case’s AFP position was again normal. Because the case was hemodynamically stable without a significant drop in haemoglobin, an optional right Adrenalectomy was performed 1 week latterly. The pathology examination showed a5.5- cm metastasis of HCC to the right adrenal gland. Two times after surgery, the case is well and without signs of excrescence rush in the scattered liver or away [4,5].

Discussion

Hepatocellular melanoma is the fifth most common cancer in the world and the third leading cause of cancer- related death.5 Liver transplant is an excellent treatment option for HCC, furnishing cure of both the excrescence and the underpinning cirrhosis in precisely named cases. Still, in 30 to 40 of cases, HCC recurs after orthotropic liver transplant. The scattered liver is the most frequent point of rush, with other frequently affected spots being the lungs, bones, and adrenal glands.

The prognostic of cases with extrahepatic metas- tases is poor, with median survival after opinion of only4.9 months. The pattern of metastasis is generally one of multiple metastatic involvements and only probative and palliative care can be offered to these cases. Systemic remedy has limited efficacy. Solitary metastasis, on the other hand, gives an occasion for radical surgical resection. Reports describing issues of surgical resection of insulated AM from HCC are limited to several case reports and small case series. The reported rate of Metachronous AM from HCC after liver resection is0.5.7 A series of cases from Lyon described 7 cases with 2 early postoperative deaths and mean survival of 38 months after adrenalectomy for the remaining 5 cases.8 Several other case reports have described good results with surgical treatment of one- sided isolated AM appearing after variable agesposttransplant. Only 1 report described a course analogous to the one described for our case. In this report from Spain, the authors described insulated left AM 6 months after orthotropic liver transplant. Left adrenalectomy was performed; still, 8 months latterly, an insulated right AM appeared and a right adrenalectomy was performed. The case was reported to be free of rush 4 times after orthotropic liver transplant [6,7].

The first AM in our case was discovered during regular follow- up. Still, the second was suspected after the case presented with signs of adrenal haemorrhage. Adrenal haemorrhage secondary to metastasis of HCC is rare. A review of cases with adrenal haemorrhagic millions set up haemorrhage caused by metastatic HCC in only 1 of 133 cases.

Possible treatment options are adrenalectomy alone, adrenalectomy after trans arterial embolization, embolization alone, or conservative treatment. Our case was hemodynamically stable with localized metastatic complaint; therefore, we judged that he'd be a good seeker for radical surgery despite bilateral Metachronous involvement of the adrenal glands. Treatment options for Metachronous AM from HCC include conservative and surgical approaches. Cases with generalized metastatic complaint, poor liver function, or poor overall performance status can be treated with trans arterial chemoembolization, alcohol injections, radiotherapy, or systemic chemotherapy.15 On the other hand, cases with good liver function and general condition with metastatic complaint confined to the adrenal gland are respectable campaigners for surgery with prospects of good survival [8-10].

Conclusion

In conclusion, insulated Metachronous bilateral AM from HCC is a rare circumstance. It should be noted that, in the absence of other excrescence dispersion, indeed bilateral adrenalectomy is applicable and can lead to long- term complaint-free survival.

Conflict of interest statement

None.

Acknowledgement

None

1. Hardy MA, Furr A, Barret JP, Barker JH (2017) The immunologic considerations in human head transplantation. Int J Surg 41: 196-202.

Indexed at, Google Scholar, Crossref

2. Barker JH, Brown CS, Cunningham M, Wiggins O, Furr A (2008) Ethical considerations in human facial tissue all transplantation. Ann Plast Surg 60: 103-109.

Indexed at, Google Scholar, Crossref

3. Lei R, Qiu R (2020) Impassable scientific, ethical and legal barriers to body-to-head transplantation. Bioethics 34: 172-182.

Indexed at, Google Scholar, Crossref

4. Suskin ZD, Giordano JJ (2018) Body -to-head transplant; a "caputal" crime? Examining the corpus of ethical and legal issues. Philos Ethics Humanit Med 13: 10.

Indexed at, Google Scholar, Crossref

5. Ozkan O, Ertosun MG, Ozkan O (2018) Technical, Immunological, and Ethical Similarities and Differences Between Vascularized Composite Allotransplantation and Solid Organ Transplantation in Current Practice. Transplant Proc 50: 3775-3782.

Indexed at, Google Scholar, Crossref

6. Park EE, Genden EM (2009) Facial transplantation: the next frontier in head and neck reconstruction. Facial Plast Surg Clin North Am 17: 271-277.

Indexed at, Google Scholar, Crossref

7. Lamba N, Holsgrove D, Broekman ML (2016) The history of head transplantation: a review. Acta Neurochir (Wien) 158: 2239-2247.

Indexed at, Google Scholar, Crossref

8. Tobin GR, Breidenbach WC, Klapheke MM, Bentley FR, Pidwell DJ, et al. (2005) Ethical considerations in the early composite tissue allograft experience: a review of the Louisville Ethics Program. Transplant Proc 37: 1392-1395.

Indexed at, Google Scholar, Crossref

9. Zhang LC, Zhao YB, Hu WL (2010) Ethical issues in penile transplantation. Asian J Androl 12: 795-800.

Indexed at, Google Scholar, Crossref

10. Giordano J (2018) Looking Ahead: The Importance of Views, Values, and Voices in Neuroethics-Now. Camb Q Healthc Ethics 27: 728-731.

Indexed at, Google Scholar, Crossref