Korean J Urol.  2013 Oct;54(10):715-717.

Nephrectomy for a Renal Metastasis of Undiagnosed Hepatocellular Carcinoma Arising From an Orthotopic Liver Transplant Undertaken for Cryptogenic Cirrhosis

• Ong KW
• Joseph B
• Gyomber DV
• Bolton DM
• Lawrentschuk N

Abstract

Urological involvement of hepatocellular carcinoma (HCC) is rare; HCC arising in an orthotopic liver transplant (OLT) is exceptionally rare. Here we report the case of a 70-year-old man who was incidentally found to have metastatic HCC in the right kidney arising from his OLT undertaken for cryptogenic cirrhosis 10 years previously. Adding to the complexity of this case was the lack of an obvious liver primary HCC at the time of the radical nephrectomy, thus making the final diagnosis all but impossible. We believe this report represents the first report of HCC metastasizing to the kidney after OLT and adds to the few reports in the literature of HCC arising in transplanted livers.

Keyword

Kidney neoplasms; Liver neoplasms; Liver transplantation; Neoplasm metastasis; Nephrectomy

MeSH Terms

Aged
Carcinoma, Hepatocellular
Fibrosis
Humans
Kidney
Kidney Neoplasms
Liver
Liver Neoplasms
Liver Transplantation
Neoplasm Metastasis
Nephrectomy
Transplants

Figure

• 

  FIG. 1 (A) Computed tomography arterial phase coronal view showing the isolated right renal mass (arrow) measuring 55 mm×45 mm in the upper pole abutting the hemidiaphragm. (B) Computed tomography venous phase axial view. The liver appears separate from the renal mass. (C) Computed tomography demonstrating ill-defined low-attenuation lesions (arrows) in the liver consistent with hepatocellular carcinoma, 5 months after the nephrectomy. (D) Computed tomography of the chest demonstrating multiple new pulmonary metastases 5 months after nephrectomy.

• 

  FIG. 2 Histopathology. (A) Hepatoid cells with large nuclei (×40); (B) section showing positive cytoplasmic staining for Hep-Par 1 (×100); (C) positive staining for polyclonal carcinoembryonic antigen (pCEA) (×100). Hep-Par 1 is a hepatocyte-specific antibody with an 82% sensitivity and 90% specificity for diagnosis of hepatocellular tumors. The usefulness of Hep-Par 1 is enhanced when it is combined with pCEA.

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