Extrahepatic Mets after Liver Transplantation for HCC months after the liver transplantation, a newly-developed 3 cm-sized heterogeneous mass was found in the hilum of the spleen (Fig. 3A and B). The laboratory values showed he- moglobin of 10.7 g/dL, WBC of 3400/μL, platelet count of 146,000/μL, albumin of 4.4 g/dL, AST/ ALT of 18/9 IU/L, total bilirubin of 0.4 mg/dL, prothrombin time of 11.0 sec, and AFP of 2.15 IU/mL. The patient was closely observed for three months, and a splenectomy was performed in July 2007 due to a mass growth without evidence of intrahepatic recurrence or distant metastasis. A well-defined, white, sol- id mass measuring 6 × 5 × 4.5 cm was found. It was partial- ly encapsulated and was pathologically compatible with metastatic HCC (Fig. 3C and D). Because the lesion invad- ed the perisplenic space, the patient received radiation ther- apy on the splenectomy site following an uneventful post- operative recovery. The radiation dosage was 50.4 Gy. The patient demonstrated no evidence of recurrence for 15 months. The patient received only adjuvant radiation thera- py without any other treatment modality. However, a fol- low-up CT scan taken 15 months after the splenectomy demonstrated two nodular lesions in segment VI of the liv- er compatible with HCCs. He then received TACE for 4 times. However, he was in the progressive disease status and was expired 29 months after the splenectomy. A B Fig. 2. A CT scan demonstrates a ruptured HCC located in segment VIII of the liver (A). Central bisectionectomy was performed following TACE, and the mass was a 5.7 cm HCC with 60% necrosis (B). HCC, hepatocellular carcinoma. A B C D Fig. 3. A newly-developed, 3 cm-sized heterogeneous mass was found in the hilum of the spleen after liver transplantation (A and B). Pathologic specimen following splenectomy (C) and microscopic exam, Hematoxylin & Eosin stain, ×40 (D). Yonsei Med J http://www.eymj.org Volume 52 Number 1 January 2011 201