经常性肝细胞癌（HCC）是肝移植后面临的重大挑战，在大约10-23％的患者中发生，中位出现时间为移植后的13个月。肝移植患者中常见出现肝外侵犯，如肺、骨、肾上腺、腹膜、淋巴结和中枢神经系统（CNS）。值得注意的是，血管侵犯（VI），包括微血管侵犯（MiVI）和宏血管侵犯（MVI），分别增加了2.42倍和7.82倍的复发风险。本文介绍了一例独特的病例，一个72岁有乙型肝炎相关肝硬化和HCC病史的男性患者接受了原位肝移植（OLT）。六年后，他因摔倒前往急诊科就诊，期间在影像学检查中发现了T7的病理性骨折和偶然的颅内肿块。随后的活组织检查证实了T7病灶的转移性HCC，而核磁共振成像显示了两个增强的脑部肿块。一个肿块在左顶颞叶测量为4.8cm，另一个在右额回测量为1.7cm。值得注意的是，患者在OLT时显示出MiVI和轻度升高的甲胎蛋白水平（AFP），为7.6ng/mL。这个病例强调了MiVI在肝移植后HCC复发中的预测价值。因此，对于患有HCC和MiVI的患者，延长移植后的监测非常重要。此外，本报告突出了HCC患者接受OLT后延迟性脑转移的罕见情况。© 2023. 日本消化器学会。

Recurrent hepatocellular carcinoma (HCC) poses a significant challenge after liver transplantation, affecting approximately 10-23% of patients with a median onset of 13 months post-transplantation. Extrahepatic involvement, such as lung, bone, adrenal glands, peritoneum, lymph nodes, and central nervous system (CNS), is commonly observed among transplant recipients with HCC recurrence. Notably, vascular invasion (VI), including microvascular invasion (MiVI) and macrovascular invasion (MVI), substantially increase the risk of recurrence by 2.42- and 7.82-fold, respectively. This article presents a unique case of a 72-year-old male patient with a history of HCV-related cirrhosis and HCC who underwent orthotopic liver transplantation (OLT). Six years later, he presented to the emergency department following a fall, which led to the discovery of a pathologic fracture of T7 and an incidental intracranial mass during imaging. Subsequent biopsy confirmed metastatic HCC in the T7 lesion, while magnetic resonance imaging revealed two enhancing brain masses. One mass measured 4.8 cm in the left occipitotemporal lobe, and the other measured 1.7 cm in the right frontal gyrus. Notably, the patient had exhibited MiVI and a mildly elevated alpha-fetoprotein level (AFP) of 7.6 ng/mL at the time of his OLT. This case underscores the predictive value of MiVI in HCC recurrence post-OLT. Accordingly, extended post-transplantation surveillance is crucial for patients with HCC and MiVI. Moreover, this report highlights the uncommon occurrence of delayed brain metastasis following OLT in a patient with HCC.© 2023. Japanese Society of Gastroenterology.