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Case Reports
. 2025 May 2;17(5):e83344.
doi: 10.7759/cureus.83344. eCollection 2025 May.

A Rare Presentation of Hepatocellular Carcinoma: Adrenal Metastasis Mimicking Primary Adrenal Malignancy

Ryan D Muchard  1 , Erin G Park  1 , Carson Woodward  2 , Christopher D Johnson  3
Affiliations
Case Reports

A Rare Presentation of Hepatocellular Carcinoma: Adrenal Metastasis Mimicking Primary Adrenal Malignancy

Ryan D Muchard et al. Cureus. .

Abstract

Hepatocellular carcinoma (HCC), a primary liver malignancy, often metastasizes to extrahepatic organs, including the adrenal glands. Differentiating metastatic HCC from primary adrenal tumors is diagnostically challenging, particularly in patients with chronic liver disease, and underscores the significance of this rare case. A 74-year-old African American male with a history of hepatitis C and hepatic fibrosis treated eight years prior, presented with significant weight loss, left upper quadrant pain, and an 8 cm positron emission tomography (PET)-avid, standard uptake value (SUV) 6.2 left adrenal mass. Imaging and biochemical evaluations suggested a non-functional adrenal tumor, initially favoring a primary adrenal malignancy. Surgical resection revealed high-grade hepatoid carcinoma on histopathology, and immunohistochemistry indicated either a primary adrenal tumor or metastatic HCC. Postoperative biopsy of a concurrent hepatic lesion confirmed HCC, establishing the adrenal mass as a rare case of metastatic HCC with the adrenal gland as the dominant presentation. This case underscores the diagnostic challenges in differentiating between primary adrenal tumors and metastatic HCC in patients with chronic liver disease. A multidisciplinary approach incorporating imaging, biopsy, histopathology, and immunohistochemistry is essential for accurate diagnosis. This rare presentation emphasizes the importance of considering metastatic HCC in adrenal masses associated with liver pathology, enhancing clinical awareness and diagnostic precision.

Keywords: adrenal glands; adrenal malignancy; hepato cellular carcinoma; robotic surgical procedures; tumor removal.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Non-contrast CT scan of the chest and abdomen
Green arrow points to the 8 × 11 cm mass in the left upper quadrant, originating from the adrenal gland.
Figure 2
Figure 2. MRI Imaging
A. T1-weighted coronal MRI slice shows a large mass in the left adrenal gland indicated by the green arrow. B. Axial MRI slice demonstrates the tumor's full width, green arrow indicating the adrenal mass. C. The green arrow indicates the 2.8 cm hepatic lesion observed in the right lateral segment of the liver.
Figure 3
Figure 3. PET scan
The green arrow is showing increased radiopharmaceutical uptake in the left adrenal gland.
Figure 4
Figure 4. Successful left adrenalectomy
Intraoperative imaging shows the cavity left after the mass excision indicated by green arrow.
Figure 5
Figure 5. Ultrasound imaging of the liver
The green arrow is demonstrating the hepatic mass during Interventional radiology core needle biopsy. Sonographic evaluation of the right hepatic lobe demonstrates a mixed echogenic mass.
See this image and copyright information in PMC

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