Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 18, 2016; 8(23): 994-998
Published online Aug 18, 2016. doi: 10.4254/wjh.v8.i23.994
Metastatic recurrence to a solitary lymph node four years after hepatic lobectomy for primary hepatocellular carcinoma
Michael L Caparelli, Nathan J Roberts, Timothy S Braverman, Robert M Stevens, Edward R Broun, Shyam Allamaneni
Michael L Caparelli, Nathan J Roberts, Shyam Allamaneni, Department of Surgery, the Jewish Hospital, Cincinnati, OH 45236, United States
Timothy S Braverman, Department of Pathology, the Jewish Hospital, Cincinnati, OH 45236, United States
Robert M Stevens, Department of Radiology, the Jewish Hospital, Cincinnati, OH 45236, United States
Edward R Broun, Department of Oncology, Hematology Care, Inc., Cincinnati, OH 45236, United States
Author contributions: Caparelli ML wrote the paper; Caparelli ML, Roberts NJ and Allamaneni S designed the report and edited the content; Roberts NJ and Allamaneni S performed the operation; Braverman TS provided pathology report and micrographs; Stevens RM provided critical findings for imaging studies; Broun ER contributed intellectual discussion of the patient case; all members edited the report.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at the Jewish Hospital in Cincinnati.
Informed consent statement: The patient involved in this study gave her verbal consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Shyam Allamaneni, MD, Surgical Oncologist, Department of Surgery, the Jewish Hospital, 4777 E Galbraith Road, Cincinnati, OH 45236, United States.
Telephone: +1-513-6865392 Fax: +1-513-6865394
Received: March 14, 2016
Peer-review started: March 14, 2016
First decision: April 20, 2016
Revised: May 9, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: August 18, 2016

This report describes a patient that developed recurrent metastatic hepatocellular carcinoma (HCC) to a suprapancreatic lymph node four years after being treated for primary HCC via complete left hepatectomy. Metastatic HCC was proven by pathologic confirmation. The report addresses the role of surgical resection as a treatment modality for recurrent HCC to solitary lymph nodes. The role of biological chemotherapy as adjuvant treatment is also addressed.

Keywords: Hepatocellular carcinoma, Lymph node, Recurrence, Metastatic, Extrahepatic

Core tip: Recurrence of primary hepatocellular carcinoma to a solitary extracellular site is a rare occurrence, especially after complete hepatic lobectomy for the primary tumor. In this report we describe a case of recurrence to a solitary suprapancreatic lymph node four years after initial resection. This is the only report to describe such a recurrence this long after the primary resection.