Medical Exploration: A Comprehensive Case Study of an Adrenal Mass Linked with Hepatitis C, Nephrectomy, and Multifaceted Patient Care

Abstract A 53-year-old government police officer from Gujranwala, presented with left flank pain and a left kidney stone, treated with extracorporeal shock wave lithotripsy. The patient had comorbidities including Hepatitis C and insulin-dependent diabetes. Hepatitis C had been previously treated with oral medication and interferon. Further investigation revealed a large, inoperable left suprarenal tumour compressing the left kidney, diagnosed as an adrenal adenoma. Due to the significant tumour effect, nephrectomy and left-open radical adrenalectomy were performed. Histopathological examination confirmed metastatic hepatocellular carcinoma within the adrenal gland. Immunohistochemistry supported this diagnosis with positive Hep-Par1 and Arginase markers. Postoperatively, the patient experienced left-sided hemorrhagic leakage, managed conservatively without evidence of persistent bleeding. Although hepatocellular carcinoma was not found, a high-grade dysplastic nodule was observed. Sorafenib treatment was initiated due to medication intolerance. Follow-up showed no urological complications. This case highlights the complexity of managing metastatic hepatocellular carcinoma with adrenal involvement in a patient with multiple comorbidities.