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BIBTEX RIS

Synchronous Hepatocellular Carcinoma and Renal Cell Carcinoma in a Liver Transplant Recipient: A Case Report

2007; Wolters Kluwer; Volume: 84; Issue: 12 Linguagem: Inglês

10.1097/01.tp.0000296469.78853.83

1534-6080

José Huygens Parente Garcia, Gustavo Coelho, Fernanda Paula Cavalcante, José Telmo Valença, Ivelise Regina Canito Brasil, Gleydson Cesar‐Borges, Paulo Everton Garcia Costa, Cyntia Ferreira Gomes Viana, Tarciso Daniel Santos Rocha, J.B.M. Vasconcelos,

Cholangiocarcinoma and Gallbladder Cancer Studies

A 52-year-old male with liver cirrhosis secondary to hepatitis virus C, Child-Pugh score of C10, and Model for End-stage Liver Disease score of 20 was listed for liver transplant. During the pretransplant management, an abdominal computed tomography (CT) and magnetic resonance imaging (MRI, Fig. 1) showed a 2.7×2.2 cm mass in the liver and a 1.7×1.2 cm tumor in the right kidney. The liver mass on the CT was hyperdense with the liver parenchyma in the early arterial phase of contrast enhancement and hypodense in the portal phase; on the MRI, on T1-weighted sequences, it was hypointense to the liver and, on T2-weighted, it was hyperintense, suggesting hepatocellular carcinoma (HCC). The renal tumor on the CT and was a solitary solid lesion with contrast enhancement during the arterial phase; on the MRI, on T2-weighted images, it was hyperintense to the liver; on T1-weighted, it was hypointense, with a high degree of confidence in diagnosing renal cell carcinoma (RCC).FIGURE 1.: MRI of the upper abdominal cavity showing a mass in the right lobe of the liver and another one the in upper portion of the right kidney.Being a Child-Pugh C patient, he had a prohibitive risk to perform either a biopsy of the kidney tumor or its resection. Based on the fact that renal metastasis from a primary hepatocellular carcinoma is a extremely rare event (1), on the initial stage of both tumors and finally on the MRI and CT findings, we considered the possibility of two synchronous tumors and decided not to contraindicate the liver transplant. During the liver transplantation procedure, after the recipient's hepatectomy, we performed a partial nephrectomy to resect the kidney mass. Then, the donor liver was implanted. Histopathological analysis confirmed a synchronous HCC and RCC. He showed a good recovery and left the hospital 7 days after the transplant. His immunosuppression regimen was based on tacrolimus and prednisone. After a 12-month follow-up, patient is alive with good graft function and has no clinical or CT sign of any other tumor. Synchronous early primary cancers are rare. One study showed an incidence of 3.7% of synchronous cancers related to RCC. The most common sites involved were prostate, bladder, and lung. The occurrence of synchronous RCC and HCC is extremely rare (2). There is just one case of synchronous HCC and RCC resected simultaneously during a liver transplantation procedure, recently published on the literature (3). The prognosis of RCC is not likely to be changed by immunosuppression. However, a 5-year follow-up is necessary to confirm the results. The possibility of a synchronous tumor should be considered in cirrhotic patients with HCC. Jose Huygens Parente Garcia Gustavo Rego Coelho Fernanda Paula Cavalcante Jose Telmo Valença Junior Ivelise Regina Canito Brasil Gleydson Cesar-Borges Paulo Everton Garcia Costa Cyntia Ferreira Gomes Viana Tarciso Daniel Santos Rocha Joao Batista Marinho Vasconcelos Centro de Transplante de Figado do Ceara Hospital Universitario Walter Cantidio Fortaleza, Brazil