Retroperitoneal hemorrhage of adrenal metastasis from hepatocellular carcinoma during lenvatinib treatment

Abstract

A 72-year-old woman with lung metastases and right adrenal metastasis from hepatocellular carcinoma was treated with lenvatinib. Progressive disease was observed on computed tomography (CT) 12 weeks after the initial treatment with lenvatinib. Two days later, she complained of a sudden onset of right upper quadrant pain; the CT showed retroperitoneal hemorrhage due to right adrenal metastasis. Emergent angiography displayed the extravasation and transcatheter arterial embolization (TAE) was performed from the right inferior phrenic artery. The patient's abdominal pain improved gradually, and she was discharged 18 days after TAE. We retrospectively reviewed the CT findings 12 weeks following the initial treatment with lenvatinib, showing that an area of high attenuation was apparent on the caudal side of the tumor, suggesting intratumoral hemorrhage. The close screening for presence of intratumoral hemorrhage was required during lenvatinib treatment.