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

## TL;DR

A rare case of liver cancer spreading to the adrenal gland was mistaken for a primary adrenal tumor, highlighting the need for careful diagnosis in patients with liver disease.

## Contribution

This case report highlights the diagnostic challenge of distinguishing metastatic HCC from primary adrenal tumors in patients with chronic liver disease.

## Key findings

- A 74-year-old patient with a history of hepatitis C presented with an adrenal mass initially thought to be a primary tumor.
- Histopathology and biopsy confirmed the adrenal mass was metastatic hepatocellular carcinoma.
- The case emphasizes the importance of a multidisciplinary approach for accurate diagnosis in similar cases.

## 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.