[Metastasis in the frontal skull base from hepatocellular carcinoma]

A Case of Sphenoid Sinus Metastasis in Hepatocellular Carcinoma

Sphenoid sinus metastasis from hepatocellular carcinoma (HCC) has been reported only rarely. We present a case of solitary sphenoid sinus metastasis of a 2.7 × 2.3 cm single HCC lesion. (Hepatology 2016;63:2050-2053).

Solitary skull metastasis as the first symptom of hepatocellular carcinoma: case report and literature review

Skull metastasis from hepatocellular carcinoma (HCC) is reported rarely. In addition, solitary skull metastasis as the first symptom of HCC is reported even less. Here, we reported a case of solitary skull metastasis as the first symptom of HCC and reviewed the literature on skull metastasis. A 49-year-old male patient was admitted to Jinjiang Hospital of Quanzhou Medical College with a painless parietal-occipital scalp mass, and he denied any history of hepatic disease. A cranial computed tomography demonstrated a hypervascular enhancement with osteolytic change in the right parietal-occipital region, cranial magnetic resonance imaging indicated a highly enhanced and osteolytic skull tumor, and abdominal computed tomography showed a huge tumor in the liver. The other examinations showed no other metastases. Laboratory data showed no liver dysfunction while hepatitis B surface antigen was positive, and alpha fetal protein level was high. A craniectomy was performed and the mass was totally removed. The histological diagnosis was skull metastasis from HCC. The patient was subsequently treated by transcatheter arterial chemoembolization. In a review of published literature, the incidence of skull metastasis from HCC in the period between 1990 and 2011 has significantly increased. The misdiagnosis rate of skull metastases as the first symptom from HCC was high. Therefore, it is necessary to give each patient with a scalp mass that has invaded the skull a liver ultrasound or computed tomography scan. On the other hand, we found that metastases that occurred in the calvaria site were more frequent than those that occurred in the skull base and facial skeleton. This may be worthy of further investigation in the future.

Isolated skull base metastasis as the first manifestation of hepatocellular carcinoma--a rare case report with review of literature

INTRODUCTION

Hepatocellular carcinoma rarely metastasizes to skull base.

CASE REPORT

We report an extremely rare case of solitary skull base metastasis without metastasis to any other site, with right third, fourth, and sixth cranial nerve palsy as the initial manifestation of the disease.

DISCUSSION

The biopsy specimen of skull base lytic lesion suggested metastatic hepatocellular carcinoma. Subsequent examination revealed a large mass involving superior segment of right lobe of liver, which was confirmed as hepatocellular carcinoma on histopathological examination.

CONCLUSION

Until now, there have been only 24 cases of hepatocellular carcinoma metastasizing to skull base cited in literature. We report here an unusual case of solitary skull base metastasis from hepatocellular carcinoma prior to the diagnosis of primary tumor.

Unusual presentation of metastatic hepatocellular carcinoma in the nasal septum: a case report and review of the literature

Hepatocellular carcinoma with sinonasal metastasis is extremely rare. We report a case of a 49-year-old man who had a history of synchronous hepatocellular carcinoma and verrucous carcinoma of tongue. A painless and non-bleeding mass was found in the left nasal septum 16 months after hepatocellular carcinoma was diagnosed. On computed tomography, the mass was enhanced with contrast. It was resected and proved to be metastatic hepatocellular carcinoma. The patient was treated with radiotherapy to the nasal area and then with chemotherapy. He was still alive, 15 months after the appearance of the nasal metastasis.

Skull metastasis from hepatocellular carcinoma

Metastasis to the skull frequently occurs in patients with lung, breast and prostate cancer. However, skull metastases from hepatocellular carcinoma (HCC) have been rarely reported. We review the literature on skull metastasis from HCC and report a case of a 46-year-old male, who was diagnosed as HCC and was operated on by trans-arterial embolization and lobectomy in Oct. 2004. He complained of a painless mass over the left frontal region for two months. Radiograph of the skull revealed an osteolytic mass about 4-5 cm in size over the left frontal region. A cranial computerized tomography demonstrated a destructive lesion with soft tissue mass over the left frontal region. A left frontal craniectomy was performed and tumor was totally removed. The histological diagnosis was cranial metastasis from HCC. Postoperative recovery was uneventful without any neurological deficits. Because of improved and advancing treatment for HCC, survival time for HCC has been lengthened and distant metastases will thus be found to increase. Early diagnosis is essential to treat the primary disease. Skull metastases from HCC should be considered as a differential diagnosis in patients with scalp subcutaneous mass and osteolytic defect on X-ray skull films.

Skull-base metastases

Metastasis to the skull-base particularly affects patients with carcinoma of the breast and prostate. Clinically, the key feature is progressive ipsilateral involvement of cranial nerves. Five syndromes have been described according to the metastatic site including the orbital, parasellar, middle-fossa, jugular foramen and occipital condyle syndromes. Magnetic resonance imaging (MRI) is nowadays the most useful examination to establish the diagnosis but plain films, CT scans with bone windows and isotope bone scans remain helpful to demonstrate bone erosion. Normal imaging studies do not exclude the diagnosis. The treatment depends on the nature of the underlying tumor. Radiotherapy is generally the standard treatment, while some patients with chemosensitive or hormonosensitive lesions benefit from chemotherapy or hormonotherapy and selected patients from surgical removal. Gamma Knife radiosurgery is sometimes a useful alternative, particularly for previously irradiated skull-base regions, and for small tumors (diameter < 30 mm). The overall prognosis is poor, with an overall median survival of about 2.5 years, probably because skull-base metastases appear late in the course of the disease.

Head and neck metastases from occult abdominal primary site: a case report and literature review

OBJECTIVES

A very rare case of cervical lymph node metastasis from the liver is reported. The clinical findings and the diagnosis of a metastasis to the head and neck from the isolated silent abdominal cancer are discussed.

MATERIAL AND METHODS

The clinical and histopathological findings of a 56-year-old woman with a metastatic cervical lymph node of unknown origin are presented, together with a literature review of metastases from an occult abdominal primary.

RESULTS

The primary site was identified as an undifferentiated cholangiolocellular carcinoma using immunostaining for anti-cytokeratin subclasses after autopsy. Fifty-two cases of head and neck metastases from an abdominal primary cancer were found and separately summarized according to the metastatic routes.

CONCLUSIONS

When a metastatic neck cancer of unknown origin is diagnosed, it is very important to consider the possibility of a metastasis from an abdominal organ. Recognition of metastatic routes and their characteristics is helpful in the search for the occult abdominal primary site. Immunohistochemistry of the metastatic cancer may provide important information for identifying the primary site in cases of metastasis of an undifferentiated carcinoma.