Undetectable Brain Metastasis of Hepatocellular Carcinoma by PET-CT After Liver Transplantation

Şahin E. , İnce V. , Kutlu R. , Paşahan R. , Şahin T. T. , Yılmaz S.

International Liver Symposium of ISLS, Seoul, South Korea, 11 - 12 March 2022, pp.1

  • Publication Type: Conference Paper / Full Text
  • City: Seoul
  • Country: South Korea
  • Page Numbers: pp.1


Introduction: Brain metastasis after liver transplantation is a very rare recurrence site for hepatocellular carcinoma and diagnosis of this condition can be challenging.

Method: A 61-year-old male patient undergone living donor liver transplantation for hepatitis B virus-related hepatocellular carcinoma which is downstaged by transarterial chemo and radioembolization. AFP blood level increased on postoperative first year. PET-CT revealed pathologic metabolic activity at the localization of synthetic vascular graft which drains segment 5 of the transplanted liver and there was no other suspectable tumor localization. Surgical resection of synthetic vascular graft area was performed, but there was no tumor at the pathology report of the specimen. Systemic chemotherapy was started due to undetectable metastatic HCC. ​Four months later, after surgical resection of the vascular graft, the patient was applied with loss of consciousness.

Result: Brian metastasis of HCC was detected on computed tomography. Surgical resection of brain metastasis was performed, and pathology confirmed the HCC metastasis. Intracranial metastasis of HCC is very rare after liver transplantation. ​At the time of diagnosis, the patient with HCC who was AFP> 1000ng / ml and received a full response to loco-regional treatment was performed LDLT, and brain metastasis was detected at post-tx 16th month and died due to tumor progression in 20th.  In the case of high AFP level after liver transplantation for HCC cannot be explained by PET-CT, brain metastasis should be kept in mind, and conventional cranial imaging like tomography or magnetic resonance imaging should be done.


Conclusion: In case of unexplained high AFP levels after transplantation, it is beneficial to keep in mind the brain metastases and to perform cranial scanning with conventional imaging methods (CT, MRI) rather than FDG PET.