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Case report
Pharyngeal metastasis following living-donor liver transplantation for hepatocellular carcinoma: case report and review of literature
Taiji Tohyama
Kurashiki Medical Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5422-8893
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: 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.
Case presentation: 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 nodes 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.
Conclusion: 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.
Keywords
hepatocellular carcinoma, pharyngeal metastasis, nasopharynx, liver transplantation, vertebral venous plexus
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This preprint is under consideration at World Journal of Surgical Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Case report
Pharyngeal metastasis following living-donor liver transplantation for hepatocellular carcinoma: case report and review of literature
Taiji Tohyama
Kurashiki Medical Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5422-8893
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 15 May, 2020
No community comments so far
Editor assigned
On 03 May, 2020
Submission checks complete
On 02 May, 2020
Editor invited
On 02 May, 2020
No comments provided
Editorial decision: Major Revision
On 12 Apr, 2020
Review #1 received
Received 11 Apr, 2020
Review #3 received
Received 10 Apr, 2020
Review #2 received
Received 06 Apr, 2020
Review #4 received
Received 04 Apr, 2020
Reviewer #4 agreed
On 02 Apr, 2020
Reviewer #3 agreed
On 01 Apr, 2020
Reviewer #2 agreed
On 30 Mar, 2020
Reviewer #1 agreed
On 29 Mar, 2020
Reviewers invited
Invitations sent on 07 Mar, 2020
Editor assigned
On 06 Mar, 2020
First submitted
On 05 Mar, 2020
Submission checks complete
On 05 Mar, 2020
Editor invited
On 05 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: 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.
Case presentation: 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 nodes 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.
Conclusion: 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.
Figure 1
Figure 2
Figure 3