Pharyngeal metastasis following living-donor liver transplantation for hepatocellular carcinoma: a case report and literature review

• Published in: World journal of surgical oncology Vol. 18; no. 1; pp. 109 - 8
• Main Authors: Tohyama, Taiji, Sakamoto, Katsunori, Tamura, Kei, Nakamura, Taro, Watanabe, Jota, Wakisaka, Hiroyuki, Takada, Yasutsugu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28-05-2020; BioMed Central; BMC
• Subjects: Abdomen; Adrenal glands; Allografts - diagnostic imaging; Allografts - pathology; Allografts - surgery; Biopsy; Cancer metastasis; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - secondary; Carcinoma, Hepatocellular - therapy; Care and treatment; Case Report; Case reports; Case studies; Catheter Ablation; Chemotherapy; Chemotherapy, Adjuvant - methods; Cirrhosis; Complications and side effects; Development and progression; Dissection; Drug Combinations; End Stage Liver Disease - etiology; End Stage Liver Disease - surgery; Hepatectomy; Hepatitis; Hepatitis B; Hepatocellular carcinoma; Humans; Hypopharynx; Literature reviews; Liver; Liver - diagnostic imaging; Liver - pathology; Liver - surgery; Liver cancer; Liver cirrhosis; Liver diseases; Liver Neoplasms - complications; Liver Neoplasms - diagnosis; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Living Donors; Lungs; Lymph nodes; Lymphatic Metastasis - diagnostic imaging; Lymphatic system; Male; Medical prognosis; Metastases; Metastasis; Middle Aged; Nasopharynx; Neck; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Nodes; Oxonic Acid - therapeutic use; Patients; Pharyngeal cancer; Pharyngeal metastasis; Pharyngeal Neoplasms - diagnosis; Pharyngeal Neoplasms - secondary; Pharyngeal Neoplasms - therapy; Pharynx; Pharynx - diagnostic imaging; Pharynx - pathology; Pharynx - surgery; Positron Emission Tomography Computed Tomography; Sorafenib - therapeutic use; Surgery; Survival; Tegafur - therapeutic use; Transplantation; Transplants & implants; Treatment Outcome; Tumors; Veins & arteries; Vertebral venous plexus; Viruses; Japan; Hepatocellular carcinoma; Nasopharynx; Pharyngeal metastasis; Liver transplantation; Vertebral venous plexus
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-020-01873-0

The most common sites of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been reported to be the liver, lung, bone, and adrenal glands, but there have also been many reports of cases of multiple recurrence. The prognosis after recurrence is poor, with reported median survival after recurrence of HCC ranging from 9 to 19 months. Here, we report a case of long-term survival after recurrence of pharyngeal metastasis following living-donor liver transplantation (LDLT) for HCC within the Milan criteria, by resection of the metastatic region and cervical lymph node dissection.
A 47-year-old man with a Model End-stage Liver Disease (MELD) score of 11 underwent LDLT for HCC within the Milan criteria for liver cirrhosis associated with hepatitis B virus infection, with his 48-year-old elder brother as the living donor. One year and 10 months after liver transplantation, he visited a nearby hospital with a chief complaint of discomfort on swallowing. A pedunculated polyp was found in the hypopharynx, and biopsy revealed HCC metastasis. We performed pharyngeal polypectomy. Two years later, cervical lymph node metastasis appeared, and neck lymph node dissection was performed. Although recurrence subsequently occurred three times in the grafted liver, the patient is still alive 12 years and 10 months after recurrence of pharyngeal metastasis. He is now a tumor-free outpatient taking sorafenib.
It is necessary to recognize that the nasopharyngeal region is a potential site of HCC metastasis. Prognostic improvement can be expected with close follow-up, early detection, and multidisciplinary treatment, including radical resection.