A Case of the Unusual Metastases to the Inguinal and Para-Aortic Lymph Nodes from Hepatocellar Carcinoma

Ken Ishikawa, Toshiomi Kusano, Takashi Hirayama, Masayasu Naitou*, Yukiko Ishibashi, Yoshitaka Uji, Takashi Takao, Kazuyuki Tachibana and Masahiro Kamachi*

Shin-Koga Hospital
Koga-21 Hospital*

We report a patient with hepatocellular carcinoma (HCC) treated successfully in two hepatic resections and two lymph adenectomies of metastatic inguinal and para-aortic nodes. A 69-year old man diagnosed with chronic hepatitis C following a blood transfusion during gastric cancer surgery in 1980, was found later to have a tumor in the posterior inferior segment of the liver necessitating partial hepatic resection in 1995. The lesion was histologically diagnosed to be HCC. Since 1995, for recurrent HCC, he underwent percutaneous transcatheter arterial embolization twice. In January 2000, a right inguinal mass was found and resected. Histopathologically, it was lymph node metastasis from HCC. Because no other extrahepatic lesions were identified, we conducted right hepatectomy for the remnant tumor in March 2000. Serum tumor markers normalized thereafter and we continued close observation. Abdominal ultrasonography in June 2003 showed a swollen para-aortic lymph node and serum tumor markers rose gradually, necessitating lesion resection. The lesion was histologically diagnosed to be lymph node metastasis from HCC in August of the same year. Serum tumor markers decreased to within normal limits after surgery. The patient has shown no evidence of tumor recurrence in the more than 9 years since initial presentation.

Key words
femoral lymph nodes metastasis, para-aortic lymph nodes metastasis, hepatocellar carcinoma

Reprint requests
Ken Ishikawa Department of Surgery, Shin-koga Hospital
120 Tenjin-cho, Kurume, 830-8577 JAPAN

Accepted
February 23, 2005

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