A Rare Presentation of Hepatocellular Carcinoma: Adrenal Metastasis Mimicking Primary Adrenal Malignancy

Hepatocellular carcinoma (HCC), a primary liver malignancy, often metastasizes to extrahepatic organs, including the adrenal glands. Differentiating metastatic HCC from primary adrenal tumors is diagnostically challenging, particularly in patients with chronic liver disease, and underscores the significance of this rare case. A 74-year-old African American male with a history of hepatitis C and hepatic fibrosis treated eight years prior, presented with significant weight loss, left upper quadrant pain, and an 8 cm positron emission tomography (PET)-avid, standard uptake value (SUV) 6.2 left adrenal mass. Imaging and biochemical evaluations suggested a non-functional adrenal tumor, initially favoring a primary adrenal malignancy. Surgical resection revealed high-grade hepatoid carcinoma on histopathology, and immunohistochemistry indicated either a primary adrenal tumor or metastatic HCC. Postoperative biopsy of a concurrent hepatic lesion confirmed HCC, establishing the adrenal mass as a rare case of metastatic HCC with the adrenal gland as the dominant presentation. This case underscores the diagnostic challenges in differentiating between primary adrenal tumors and metastatic HCC in patients with chronic liver disease. A multidisciplinary approach incorporating imaging, biopsy, histopathology, and immunohistochemistry is essential for accurate diagnosis. This rare presentation emphasizes the importance of considering metastatic HCC in adrenal masses associated with liver pathology, enhancing clinical awareness and diagnostic precision.