A Case of Primary Lung Cancer Accompanying by Hepatocellular Carcinoma

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Background. The incidence of non-B non-C hepatocellular carcinoma (HCC) has been increasing in recent years. When it accompanies lung cancer, it is often difficult to distinguish it from liver metastasis. Case. A 68-year-old man presented at our hospital with bloody sputum. He contracted diabetes mellitus at 50 years of age. Tests for anti-HBs antigen and anti-HCV antibody were negative. Computed tomography (CT) showed a mass in the right S3 of the lung and swelling of hilar and mediastinal lymph nodes. An enhanced nodule was seen in S8 of the liver. We diagnosed it as squamous cell carcinoma by bronchoscopy (cT2aN2M1b-HEP, stage IV). We performed chemotherapy with cisplatin and paclitaxel. The primary lung mass and lymph nodes greatly decreased in size, but there was no reduction in the nodule in S8 of the liver. After chemotherapy, the liver nodules gradually grew. Dynamic CT of the liver and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) showed typical HCC features, and elevated levels of alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) are compatible with HCC. Laparoscopic radiofrequency ablation (LRA) was performed, and the liver nodule disappeared. We made a diagnosis of HCC from biopsy of the nodule when LRA was performed. We considered it to be cT2aN2M0, stage IIIA. Video-assisted thoracoscopic surgical (VATS) right upper lobectomy with mediastinal and hilar lymph node dissection (ND2a) was performed. Thereafter, the patient was followed with no recurrence of lung cancer or HCC. Conclusion. In patients with lung cancer, we should consider the possibility of HCC, when a liver tumor is the only distant metastatic lesion. Radiological investigations and measurement of AFP and PIVKA-II are useful and LRA should be a good choice for therapy.

A Case of Primary Lung Cancer Accompanying by Hepatocellular Carcinoma

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