Abstract
A 62-year-old woman complained of right hypochondralgia. A diagnosis of hepatocellular carcinoma (HCC) was made and transarterial chemoembolization was performed. She was referred to our hospital for surgical resection. We performed an extended right lobectomy for the huge HCC in the anterior segment of the right lobe (t3n0m0, StageIII). The pathological diagnosis was poorly-differentiated hepatocellular carcinoma. The serum AFP level started to increase three months after the operation, and a solitary mediastinal lymph node metastasis was demonstrated by chest CT scan and FDG-PET. Lymphadenectomy was performed following systemic chemotherapy. A pathological examination demonstrated the tumor cells were AFP-positive and compatible with relapse of HCC. Although the serum AFP level decreased from 5425 ng/ml to 24.4 ng/ml postoperatively, it started to increase again three months after lymphadenectomy, and multiple lung and mediastinal metastases appeared subsequently. Systemic chemotherapy was ineffective, and she died 25 months after the first operation. We report a rare case of hepatocellular carcinoma relapsing with solitary metastasis to a mediastinal lymph node.
