Case Report DOI 10.3349/ymj.2011.52.1.199 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 52(1):199-203, 2011 Solitary Extrahepatic Intraabdominal Metastasis from Hepatocellular Carcinoma after Liver Transplantation Sae Byeol Choi,1 Hyungi Kim,2 Sung Hoon Kim,3 Young Nyun Park,2 and Kyung Sik Kim3 1Department of Surgery, Korea University College of Medicine, Seoul; Departments of 2Pathology and 3Surgery, Yonsei University College of Medicine, Seoul, Korea. Received: December 3, 2008 Revised: April 20, 2009 Accepted: April 20, 2009 Corresponding author: Dr. Kyung Sik Kim, Department of Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-2125, Fax: 82-2-313-8289 E-mail: kskim88@yuhs.ac ∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A liver transplantation is a treatment option in selected patients with hepatocellu- lar carcinoma (HCC). Despite the adequate selection of candidates, recurrences of HCC may still develop. Solitary extrahepatic metastasis from HCC after a liv- er transplantation is rare. Here we report two cases of HCC demonstrated extra- hepatic recurrence to the adrenal gland and spleen, respectively, within one year after a liver transplantation. Since the treatment of solitary extrahepatic metastasis from HCC after a liver transplantation is not standardized, surgical resection was performed. In the case of HCC adrenal metastasis, innumerable intrahepatic me- tastases were found two months after the adrenalectomy. And 16 months after ad- renalectomy, the patient expired due to tumor progression and hepatic failure. In the case of HCC splenic metastasis, postoperative radiation therapy was per- formed. However, two recurrent HCC nodules were found 15 months after the splenectomy and received transarterial chemoembolization (TACE). And 29 month after the splenectomy, the patient also expired as same causes of former patient. Key Words: Hepatocellular carcinoma, adrenal metastasis, splenic metastasis, liv- er transplantation INTRODUCTION There are several treatments for hepatocellular carcinoma (HCC), and a liver transplantation can be performed in a selected group of patients as such a treat- ment. After the introduction of the Milan and University of California at San Fran- cisco (UCSF) criteria, the candidates for a liver transplantation have been expand- ed. The use of a specific selection criteria has been shown to improve tumor-free survival in patients undergoing a liver transplantation for HCC.1-3 However, de- spite the adequate selection of candidates, recurrences of HCC may still develop and result in death.4,5 The adrenal gland is a common target organ of hematoge- nous metastasis from HCC6 however, the spleen has been rarely reported as a met- astatic site of HCC. We report two cases of solitary extrahepatic metastasis from HCC after a liver transplantation treated with surgical resection. Yonsei Med J http://www.eymj.org Volume 52 Number 1 January 2011 199