Journal of hepatocellular carcinoma
Isolated Metachronous Splenic Metastasis Following Discontinuation of PD-1 Inhibitor Therapy in Hepatocellular Carcinoma: A Rare Pattern of Late Recurrence - A Case Report
By Hu X, Chen J, Li Z and 6 others.
Abstract
Background
Isolated splenic metastasis from hepatocellular carcinoma (HCC) is uncommon, with only a small number of well-characterised solitary cases reported in the English-language literature. Moreover, late extrahepatic recurrence after immune checkpoint inhibitor (ICI) discontinuation in patients achieving complete response remains poorly characterized, posing significant challenges for surveillance and management.
Case presentation
A 52-year-old woman with a 6-year history of HBV-related HCC underwent sequential treatments including hepatectomy, microwave ablation, repeat hepatectomy, and PD-1 inhibitor therapy (sintilimab), achieving a sustained complete radiological response. Approximately 18 months after ICI cessation, surveillance imaging revealed an isolated 3.0 × 2.6 cm splenic lesion with markedly elevated PIVKA-II (257.81 mAU/mL; reference <40 mAU/mL) despite normal AFP. Following multidisciplinary evaluation and preoperative splenic artery embolization, open splenectomy was performed. Histopathology confirmed metastatic HCC (Glypican-3+, Arginase-1+, CK19 focal+, Ki-67 ~30%), and PIVKA-II normalized postoperatively. Maintenance lenvatinib (8 mg daily) was initiated 5 months postoperatively as a risk-adapted strategy based on high-risk pathological features. At 12-month follow-up, the patient remained without evidence of radiological or biochemical recurrence, with excellent performance status; longer follow-up is required to confirm durability of response.