A 58-year-old man, who had undergone right hepatic lobectomy for hepatocellular carcinoma 6 years before, complained of hoarseness because of right recurrent laryngeal nerve paralysis. Chest X-ray film showed a large mass shadow in the superior mediastinum. On chest CT scan the mass was considered to be swollen paratracheal lymph nodes. Percutaneous aspiration biopsy of the mass demonstrated malignant epithelial cells. It was suspected that the hepatocellular carcinoma solitarily metastasized to the paratracheal lymph nodes. Right thoracotomy was done and the mediastinal tumor was resected. Microscopic examination of the resected specimen proved that the tumor was a metastatic hepatocellular carcinoma not of the lymph nodes, but of the fibroadipose tissue of the mediastinum. Metastasis of hepatocellular carcinoma to the mediastinal fibroadipose tissue is uncommon. To our knowledge, our case is the first report of hepatocellular carcinoma which shows such a metastasis.
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