International Journal of Scientific Reports | July 2021 | Vol 7 | Issue 7 Page 360 International Journal of Scientific Reports Paul D et al. Int J Sci Rep. 2021 Jul;7(7):360-362 http://www.sci-rep.com pISSN 2454-2156 | eISSN 2454-2164 Case Report Hepatocellular carcinoma with extrahepatic adrenal metastasis: an atypical case report Diptajit Paul, Baljit Singh*, Rakesh Dhankhar, Vivek Kaushal INTRODUCTION For the last 50-years, hepatocellular carcinoma (HCC), the primary liver carcinoma, possess a major worldwide risk to public health. Although it is still more prevalent in developing countries; there is a recent positive growth pattern in developed countries, more so 2000 onwards, as a consequences of higher prevalence of hepatitis C infection and increase in consumption of alcohol. Further appearance of extrahepatic metastasis makes it more vulnerable. New multimodality approaches are explored in literature for advanced metastatic disease which are unresectable. Although local therapy and liver transplant are carried out in a lots of case series, targeted therapies are still the standard of care in many centres especially for inoperable, metastatic cases. Here we present an atypical case of multifocal hepatocellular carcinoma with extrahepatic adrenal metastasis treated by oral targeted agent sorafenib only. CASE REPORT A 62-year old male, without any other co-morbidities, presented with upper abdomen pain of 2-months duration, which was insidious in onset, dull aching in nature, mild to moderate in intensity, gradually progressive and not radiating to any other site. It was not associated with any vomiting, altered bowel habits, or blood in stools. Patient had no associated history of fever, weight loss, anorexia, headache, chest or abdominal discomfort, pedal oedema or upper gastro-intestinal bleeding. Patient was vegetarian, non-smoker, non-alcoholic. He had a history of Koch’s 30- years back, took anti-tubercular therapy for 6-months and was cured completely; no history of viral hepatitis in past. There was no history of malignancy in family members. General physical examination revealed yellow discoloration of palm and sclera i.e. jaundice, but no signs of liver cirrhosis. Per abdomen examination revealed rigid abdomen with tenderness in right hypochondrium and hepatomegaly without any signs of ascites, dilated abdominal vein or splenomegaly. Complete hemogram and renal function test of the patient were within normal limits, but liver enzymes serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) and bilirubin (both direct and indirect) were elevated. All the relevant viral markers like hepatitis-B (HBV), hepatitis-C (HCV) and human immuno-deficiency virus (HIV) were negative, but alpha-fetoprotein (AFP) was severely raised having initial ABSTRACT Hepatocellular carcinoma with extrahepatic metastasis are a threat to public health worldwide. Lung, bones and abdominal lymph nodes are the major sites of metastasis from liver primary, adrenal metastasis being a less common site. Here we present an old male presented with upper abdominal pain diagnosed as advanced, unresectable hepatocellular carcinoma with right adrenal metastasis. Patient was treated with multi-kinase inhibitor sorafenib and outcome was acceptable with good patient compliance. Keywords: Hepatocellular carcinoma, Right adrenal metastasis, Upper abdominal pain, Sorafenib Department of Radiation Oncology, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India Received: 11 May 2021 Accepted: 02 June 2021 *Correspondence: Dr. Baljit Singh, E-mail: docbaljeet13@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20212395