Left adrenal hepatocellular carcinoma recurrence in liver transplanted patient

Hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) has been reported in less than 20% of patients fulfilling Milan Criteria. Mostly, it occurs within the liver, lungs, lymph nodes, bones and brain. A 45 years old Caucasian man affected by HCV-related liver cirrhosis with HCC, who underwent several multi-modal treatments, including hepatic resection, liver transplantation and loco regional treatment presented in our Department with an unusual mass within the left adrenal gland. No clinical signs were associated. However, considering his blood test and the high risk of HCC recurrence, a mini-invasive left surrenalectomy was performed showing HCC metastases in the left adrenal gland. This case shows that even extremely rare sites of HCC metastases have to be investigated, especially if, despite all available treatments, still persist a clinical or laboratory suspect.