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Parraga S, Pasli M, Behm H, Zeches B, Reddy R. Metastatic hepatocellular carcinoma presenting as a lytic calvarial mass. Clin Case Rep 2024; 12:e9439. [PMID: 39267956 PMCID: PMC11390487 DOI: 10.1002/ccr3.9439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 08/14/2024] [Accepted: 08/18/2024] [Indexed: 09/15/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common types of cancer. More focus is being placed on clinical presentations of distant metastasis from HCC. Head masses should be investigated even when no concerning symptoms are found in patients with prior history of alcohol abuse and liver comorbidities.
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Affiliation(s)
- Shirley Parraga
- East Carolina University Brody School of Medicine Greenville North Carolina USA
| | - Melisa Pasli
- East Carolina University Brody School of Medicine Greenville North Carolina USA
| | - Hayley Behm
- East Carolina University Brody School of Medicine Greenville North Carolina USA
| | - Breann Zeches
- Internal Medicine Department ECU Health Center Greenville North Carolina USA
| | - Revanth Reddy
- Department of Pathology and Laboratory Medicine ECU Health Center Greenville North Carolina USA
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2
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Jumean S, Elemian S, Shaaban HS, Guron G. Skull Metastasis With Orbital Invasion as a Primary Manifestation of Hepatocellular Carcinoma. Cureus 2024; 16:e55091. [PMID: 38558693 PMCID: PMC10979519 DOI: 10.7759/cureus.55091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is a common worldwide cancer with a poor prognosis despite treatment advancements. Patients typically exhibit signs and symptoms pertaining to the liver. Extrahepatic metastasis of HCC is documented to be as low as 5% of cases. Bone metastasis ranks third following lungs and regional lymph nodes. The typical locations for bone metastasis include the vertebral column, pelvis, femora, and ribs, with skull metastasis, being reported in less than 1.6% of cases. Herein, we describe a case of HCC presenting with skull metastases and orbital invasion as the initial manifestation.
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Affiliation(s)
- Samer Jumean
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
- Internal Medicine, New York Medical College, Valhalla, USA
| | - Shatha Elemian
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Hamid S Shaaban
- Hematology and Oncology, Saint Michael's Medical Center, Newark, USA
| | - Gunwant Guron
- Hematology and Oncology, Saint Michael's Medical Center, Newark, USA
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3
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Ahn KH, Ryu HS, Han MS, Choi YD, Joo SP. Spontaneous Acute Epidural Hematoma Associated With Metastatic Hepatocellular Carcinoma: A Case Report. Korean J Neurotrauma 2023; 19:384-392. [PMID: 37840619 PMCID: PMC10567519 DOI: 10.13004/kjnt.2023.19.e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/31/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023] Open
Abstract
Spontaneous acute epidural hematoma (AEDH) co-occurring with metastatic hepatocellular carcinoma (HCC) of the skull is rare, with only 7 documented cases in existing literature. This report describes the case of a 42-year-old man who presented with decreased consciousness following intermittent headaches following minor head trauma. Computed tomography imaging revealed an AEDH, prompting surgical intervention. Despite preliminary assumptions linking the causes of the trauma, surgical exploration revealed no evidence of traumatic injury. Instead, an infiltrative soft-tissue mass within the skull was identified. Histopathological examination confirmed that the mass was a metastatic HCC. Despite the successful hematoma evacuation, the patient's neurological status did not improve. This case underscores the importance of considering metastatic disease in the differential diagnosis of AEDH, particularly in patients with a history of malignant tumors, irrespective of prior indications of bone metastasis. Furthermore, it emphasizes the need to enhance diagnostic and therapeutic strategies for such complex cases.
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Affiliation(s)
- Kang hee Ahn
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Han Seung Ryu
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
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4
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Bernstein Z, Adamson DC. Solitary metastasis to the skull as the first sign of hepatocellular carcinoma in a patient in long-term remission. Surg Neurol Int 2023; 14:252. [PMID: 37560598 PMCID: PMC10408630 DOI: 10.25259/sni_77_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a common malignant tumor with a 5-year survival rate of 10%, presenting with extrahepatic metastases in 15-17% of patients. HCC-bone metastases represent approximately one-quarter of all HCC metastases, most frequently in the spine, pelvis, ribs, or femur. HCC-skull metastases, however, make up 0.4-1.6% of all HCC- bone metastases. Furthermore, solitary HCC-skull metastasis without known active primary HCC is an unusual presentation warranting further review and consideration. CASE DESCRIPTION Here, the authors report a unique case of a solitary HCC-skull metastasis in a patient without known active cancer but in long-term remission for HCC. The patient is a 69-year-old male with past HCC who presented with a nontender skull mass. A computed tomography scan showed a heterogeneously enhancing mass centered in the high left parietal bone with intracranial extension. There was a noted mass effect on the left posterior frontoparietal region without worrisome midline shift. Pathology ultimately revealed the mass to be metastatic HCC. To aid in the understanding and clinical management of this rare presentation, we reviewed the literature regarding clinical presentation, radiological features, pathology, and outcome. CONCLUSION Ultimately, early detection of the primary source of cancer is pivotal to successful treatment and prognosis, and skull lesions such as these must include HCC in the differential diagnosis.
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Affiliation(s)
- Zachary Bernstein
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States
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He Q, Deng F, Cai B, You C, Zheng S. Pituitary metastasis of hepatocellular carcinoma as the initial presentations: a case report and review of the literature. Front Oncol 2023; 13:1123855. [PMID: 37483508 PMCID: PMC10358273 DOI: 10.3389/fonc.2023.1123855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/26/2023] [Indexed: 07/25/2023] Open
Abstract
Background Extrahepatic metastasis of hepatocellular carcinoma (HCC) is common. However, pituitary metastasis of HCC is extremely rare. Our case may be helpful to extend the understanding of the disease. Case presentation A 65-year-old man presented to the outpatient department for unexplained headache and ptosis for 1 month. Brain imaging showed a slight enhancement tumor in the pituitary fossa, and the endocrinological assessment showed normal results. We considered the tumor as a non-functioning pituitary adenoma before surgery. Then, the tumor was resected by an endonasal endoscopic transsphenoidal approach. The histopathological examination results revealed the pituitary metastasis of HCC. Additional abdominal imaging revealed tumors were located in the left and right liver lobes with portal vein invasion and bilateral ilium metastases. After multidisciplinary cooperation, the patient chose chemotherapy. Conclusion We report a case of HCC metastasis to the pituitary gland that initially presented with neurological symptoms. We should consider the possibility of pituitary metastasis in HCC patients.
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Affiliation(s)
- Qiang He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Feng Deng
- Department of Hepatic Surgery, The Second Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Bowen Cai
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Songping Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Akutsu N, Kawakami Y, Numata Y, Hirano T, Wagatsuma K, Ishigami K, Sasaki S, Nakase H. A case of hepatocellular carcinoma with long-term survival by multidisciplinary treatment for cranial and skeletal muscle metastases. Clin J Gastroenterol 2022; 15:960-967. [DOI: 10.1007/s12328-022-01669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
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7
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Long X, Zhang L, Wang WQ, Zhang EL, Lv X, Huang ZY. Response of Scalp and Skull Metastasis to Anti-PD-1 Antibody Combined with Regorafenib Treatment in a Sorafenib-Resistant Hepatocellular Carcinoma Patient and a Literature Review. Onco Targets Ther 2022; 15:703-716. [PMID: 35791424 PMCID: PMC9250789 DOI: 10.2147/ott.s365652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Scalp and skull metastasis of hepatocellular carcinoma (HCC) is extremely rare. Modalities for the treatment of this disease include craniotomy, radiotherapy and chemotherapy, which are unsatisfactory. We report a case of HCC with scalp and skull metastasis and review similar cases from the literature to accumulate experience for better management of this type of HCC metastasis. Case Presentation A 54-year-old female was diagnosed with advanced HCC with posterior portal vein tumor thrombus (PVTT) at admission. She received laparoscopic microwave therapy for a large tumor in Segment 6, which was then followed by sorafenib therapy. One year later, sorafenib resistance developed, metastasis occurred in the scalp and skull, left sacroiliac joint, and lung; PVTT extended into the main portal vein and alpha-feta protein (AFP) levels exceeded 65,000 ng/mL. Systemic therapy was then substituted by regorafenib combined with sintilimab. Three months later, AFP decreased to 2005 ng/mL; meanwhile, skull and lung metastatic lesions shrank significantly. Furthermore, both lump and limp disappeared. One year after the combination of regorafenib and sintilimab, skull and lung metastasis, and PVTT were completely relieved. Moreover, primary liver lesions showed no sign of activity. With comprehensive therapy, the patient has survived for 5 years and 7 months. Conclusion Sorafenib-regorafenib sequential treatment combined with sintilimab is safe and effective when used to treat HCC skull metastasis, for which high-level evidence is needed to support this treatment strategy.
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Affiliation(s)
- Xin Long
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wen-Qiang Wang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Er-Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xing Lv
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Zhi-Yong Huang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
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Kim K, Lee J, Seong J. Skull Base Metastasis from Hepatocellular Carcinoma: Clinical Presentation and Efficacy of Radiotherapy. J Hepatocell Carcinoma 2022; 9:357-366. [PMID: 35520947 PMCID: PMC9064478 DOI: 10.2147/jhc.s361045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose Skull base metastasis (SBM) from hepatocellular carcinoma (HCC) presents detrimental survival outcomes with cranial nerve symptoms; however, they have received little attention. This study aimed to investigate the clinical presentation and efficacy of radiation therapy (RT) in patients with SBM from HCC. Patients and Methods We identified patients with SBM from HCC in Yonsei Cancer Center from 2005 to 2019. Image evaluations and SBM-related symptoms were reviewed. Overall survival was calculated using the Kaplan–Meier method and compared through the Log rank test. The oligometastasis group included patients with less than five foci of tumors, while the extensive metastasis group presented five or more sites. Results The incidence of SBM from HCC was 1.5% (58/3793 patients), commonly found in the middle cranial fossa. SBM associated symptoms presented in 51 patients, and the most common were head and neck area pain, and orbital symptoms, The palliation rate after RT was 65% (24/39 patients) for overall symptoms and 83.3% (20/24 patients) for cranial nerve symptoms. In whole cohort, overall survival was analyzed, and the median overall survival of patients with oligometastasis was better than extensive metastasis (23.7 months vs 1.8 months, p < 0.001). In subgroup who received RT (39 patients), the median overall survival was 23.7 and 2.7 months for patients with oligo and extensive metastasis, respectively (p < 0.001). Conclusion This study confirmed clinical features of SBM from HCC. Overall survival was generally poor, but patients presenting oligometastasis seemed to have possibility of relative long-term survival. Although radiation was effective in SBM-induced symptom relief, dose–response relationship in local control rate and overall survival needs further studies with larger number of patients.
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Affiliation(s)
- Kangpyo Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joongyo Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Ram A, Paul R, Viswam V, Aravind B. A Trigeminal Neuropathy From an Inactive Hepatocellular Carcinoma. Cureus 2021; 13:e20340. [PMID: 35028229 PMCID: PMC8743359 DOI: 10.7759/cureus.20340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/27/2022] Open
Abstract
Breast, lung, prostate, thyroid, and kidney carcinomas are the primary tumors that are known to have bony metastasis. Hepatocellular carcinoma (HCC) frequently involves the lung and lymph nodes and less commonly the osseous system. Numbness/persistent pain in the distribution of the trigeminal nerve is more likely a neuropathy. The causes are idiopathic(common), unintentional injury to the trigeminal nerve during surgery or trauma, blood vessel pressing the trigeminal nerve, tumor infiltration, multiple sclerosis, and stroke. Unresolved facial pains after conventional treatment should prompt additional investigation to rule out other causes. In this case, we report a trigeminal neuropathy of rare cause, which is a solitary metastasis from an inactive HCC involving the osseous structures.
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Chaudry SJ, Ranjha FR, Butt S, Nawaz S. A Rare Occurrence of Scalp Metastasis in Hepatocellular Carcinoma: Case Report. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1736679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractHepatocellular carcinoma (HCC) is the most prevalent primary liver malignancy and the fifth most common cancer worldwide. Extrahepatic spread in this type of cancer is most commonly seen in the lungs and lymph nodes and less commonly in the skeletal system. Skull metastases are exceedingly rare, with an incidence of 0.5 to 1.6% reported to date. We report a similar case of a middle-aged Asian male patient with parietal scalp swelling that was initially diagnosed as meningioma. Surgical resection was performed at a local facility. The abdominal computed tomography scan did not reveal any primary or metastatic lesion. After much deliberation, multiparametric magnetic resonance imaging was requested that showed multiple lesions in the liver. Metastatic scalp lesion should be considered a differential diagnosis in HCC regardless of liver symptoms.
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Affiliation(s)
- Samreen Javed Chaudry
- Department of Clinical & Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Fajar Rafi Ranjha
- Department of Clinical & Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Sumera Butt
- Department of Clinical & Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Samaha Nawaz
- Department of Clinical & Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
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Alomari SO, Aeshawi AJ, Jbarah O, Jaradat AA, Allouh MZ. When a road traffic accident leads to a skull metastasis from hepatocellular carcinoma: A unique case presentation. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Superior Sagittal Sinus Tumor Eroding through the Skull: An Unfamiliar Presentation of Hepatocellular Carcinoma and Literature Review. Case Rep Surg 2019; 2019:5945726. [PMID: 31781465 PMCID: PMC6875341 DOI: 10.1155/2019/5945726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/28/2019] [Indexed: 01/10/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) most commonly develops in patients with liver cirrhosis caused by hepatitis C and B virus. HCC is the most common cause of death in people with cirrhosis. The lungs, bone, and lymph nodes are frequent sites of metastasis of HCC. Patients and Methods We present a case of solitary skull metastasis as the first symptom of HCC. A literature review with regard to HCC skull metastasis was undertaken. Results This patient had HCC based on chronic hepatitis C. He presented with an erosive lesion masquerading as a scalp lipoma resulting in hepatocellular carcinoma with retrograde reflux and sinus metastases. The lesion was ultimately resected, but the patient died within one week from liver failure. Seventeen similar cases were found in the literature. Median age of the patients was 58 years with 95% being male and 35% having viral hepatitis. Surgery was the preferred treatment with chemotherapy and radiation being other options. Outcome was acceptable but baseline liver disease is a limiting factor. Discussion Cranial metastases of HCC are rare but should be considered in patients with chronic hepatitis C presenting with scalp skin lesions.
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Uei H, Tokuhashi Y, Maseda M, Nakahashi M, Sawada H, Matsumoto K, Miyakata Y, Soma H. Surgical management of coincidental metastases to upper cervical spine and skull from hepatocellular carcinoma: a case report. J Int Med Res 2018; 46:4852-4859. [PMID: 30282498 PMCID: PMC6259363 DOI: 10.1177/0300060518800875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Metastases to the skull or upper cervical spine from hepatocellular carcinoma (HCC) are very rare. We herein report a unique case of two-site surgery for both skull and upper cervical spine metastases from HCC. The patient was a 64-year-old man with cervical pain. Computed tomography (CT) revealed osteolytic change related to metastatic cervical spine and occipital bone tumors. Two-stage surgery involving posterior occipitocervical fusion and occipital bone tumor resection was performed. The patient’s pain decreased in severity, and postoperative radiotherapy and chemotherapy could be conducted. The postoperative course was favorable, and the patient exhibited improvement in his activities of daily living. Neither cervical spine X-ray examination nor CT showed any instrumentation failure, such as screw loosening, before the patient died of liver failure 13 months after surgery. Patients with both skull and upper cervical spine metastases from liver cancer may have a markedly unfavorable prognosis. Even in these patients, however, surgery as an aggressive palliative treatment may prolong the survival period or maintain the quality of life as long as the patient’s general condition permits.
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Affiliation(s)
- Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Masafumi Maseda
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Masahiro Nakahashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Koji Matsumoto
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yukihiro Miyakata
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Hirotoki Soma
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
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Delgado Maroto A, Del Moral Martínez M, Diéguez Castillo C, Casado Caballero FJ. Acute epidural haematoma as a presentation of hepatocellular carcinoma: Case report and literature review. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:177-179. [PMID: 29779760 DOI: 10.1016/j.gastrohep.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Ana Delgado Maroto
- Unidad de Gestión Clínica de Digestivo, Hospital Universitario San Cecilio, Granada, España.
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Han S, Zhang XH, Lv T, Han DH. Skull Metastasis from the Liver: Case Report and Literature Review. World Neurosurg 2017; 108:989.e15-989.e18. [PMID: 28844927 DOI: 10.1016/j.wneu.2017.08.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Calvarial metastasis from liver cirrhosis in the absence of a primary focus is exceptionally rare. Few reports of metastases from hepatocellular carcinoma of an unknown primary focus have been published. CASE DESCRIPTION A 66-year-old man with a history of Schistosoma japonicum infection presented to our hospital with a mass over the left occipital region associated with headache and dizziness. Imaging revealed a 6 × 5-cm lesion supplied principally by the left occipital artery. The metastatic tumor was removed via super-selective embolization and craniotomy. Pathology revealed that circulating tumor cells from the liver had metastasized to the calvaria. Postoperatively, no primary foci was found over 9 months of follow-up. CONCLUSIONS A calvarial mass may be an initial manifestation of hepatocellular carcinoma. Early diagnosis is important. A calvarial metastasis from the liver, although very rare, should be included in the differential diagnosis of a patient with both cirrhosis and skull mass.
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Affiliation(s)
- Shuo Han
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Hua Zhang
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Lv
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong-Hua Han
- Department of Neurosurgery, Pu Dong Hospital, School of Medicine, Shanghai Fudan University, Shanghai, China.
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Solitary Skull Metastasis as the First Presentation of a Metachronous Primary Lung Cancer in a Survivor from Pancreatic Cancer. Case Rep Oncol Med 2017; 2017:5674749. [PMID: 28811947 PMCID: PMC5546056 DOI: 10.1155/2017/5674749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/19/2017] [Indexed: 11/17/2022] Open
Abstract
Skull metastasis from lung cancer is relatively common, yet the first presentation for this malignant disease is a rare occurrence. We herein report a case of a 54-year-old female, who had a good outcome following Whipple procedure for periampullary adenocarcinoma five years before her current presentation. During a routine follow-up, she was found to have a slowly progressive painless right parietal swelling. The systemic screening workup revealed no abdominal disease, but a solitary pulmonary nodule was identified. The presence of these two lesions raised the diagnosis of metastases from a previously treated pancreatic adenocarcinoma. The patient underwent complete excision of the skull lesion and subsequent lung biopsy, both of which proved on histopathological examination to be consistent with a primary lung cancer. This case emphasizes the importance of imaging and histopathological correlation in the diagnosis of solitary skull metastases and their effect on the subsequent management.
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Miyabe-Nishiwaki T, Hirata A, Kaneko A, Ishigami A, Miyamoto Y, Yamanaka A, Owaki K, Sakai H, Yanai T, Suzuki J. Hepatocellular carcinoma with intracranial metastasis in a Japanese macaque (Macaca fuscata). J Med Primatol 2017; 46:93-100. [PMID: 28369930 DOI: 10.1111/jmp.12261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND A 23-year-old male Japanese macaque (Macaca fuscata) showed left ptosis, which progressed to exophthalmos. METHODS The macaque underwent a clinical examination, CT and MRI, and was euthanized. Necropsy and histopathological examination were performed after euthanasia. RESULTS The CT revealed and MRI confirmed an intracranial mass at the skull base with orbital extension. At necropsy, there were a large hepatic mass and an intracranial mass compressing the left temporal lobe of the brain. Histopathological and immunohistological examinations revealed that the masses were hepatocellular carcinoma (HCC) and a metastatic lesion. In both the primary and metastatic lesions, neoplastic hepatocytes were arranged mainly in a trabecular pattern. Immunohistochemically, the tumor cells were positive for cytokeratin (AE1/AE3 and CAM5.2) and hepatocyte paraffin 1 and negative for cytokeratin 7 and 20 and vimentin. CONCLUSION To our knowledge, this is the first case report of HCC with intracranial metastasis in a macaque.
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Affiliation(s)
| | - Akihiro Hirata
- Division of Animal Experiment, Life Science Research Center, Gifu University, Gifu, Japan
| | - Akihisa Kaneko
- Primate Research Institute, Kyoto University, Aichi, Japan
| | - Akiyo Ishigami
- Primate Research Institute, Kyoto University, Aichi, Japan
| | - Yoko Miyamoto
- Primate Research Institute, Kyoto University, Aichi, Japan
| | | | - Keishi Owaki
- Laboratory of Veterinary Pathology, Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - Hiroki Sakai
- Laboratory of Veterinary Pathology, Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - Tokuma Yanai
- Laboratory of Veterinary Pathology, Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - Juri Suzuki
- Primate Research Institute, Kyoto University, Aichi, Japan
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Kang DH, Shim SW, Koh SJ, Nam JG, Kim YM, Weon YC. MR imaging findings of metastatic hepatocellular carcinoma in the nasal cavity: a rare site of spread. BJR Case Rep 2016; 3:20160111. [PMID: 30363288 PMCID: PMC6159253 DOI: 10.1259/bjrcr.20160111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/04/2016] [Accepted: 10/12/2016] [Indexed: 11/18/2022] Open
Abstract
We here report an extremely rare case of metastatic hepatocellular carcinoma to the nasal cavity only with MRI scan including diffusion-weighted imaging and a brief review of previous literature case reports.
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Affiliation(s)
- Dong Hyeok Kang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sang Woo Shim
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Su Jin Koh
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jung Gwon Nam
- Department of Otorhinolaryngology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Young Min Kim
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Young Cheol Weon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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Lesion in Scalp and Skull as the First Manifestation of Hepatocellular Carcinoma. Case Rep Neurol Med 2016; 2016:2897048. [PMID: 27403358 PMCID: PMC4923563 DOI: 10.1155/2016/2897048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/25/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and the fifth most common cancer in the world. The lungs, bone, and lymph nodes are frequent sites of metastasis of HCC. The purpose of the present study is show that metastases, although rare, must be among the differential diagnosis of skin lesions and that a diagnostic research based on these findings can be conducted. The authors report a rare case of metastatic hepatocellular injury to the scalp and skull treated by a radical surgical approach. Excision of the lesion in the scalp was performed “en bloc.” The tumor was supplied by the frontal branch of the superficial temporal artery. There are few case reports of metastatic HCC to scalp and skull; treatment of these lesions should be individualized in order to control symptoms, improve quality of life, and promote an increase in survival.
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Reconstruction of Rare Skull Metastases Using Free Latissimus Dorsi Flap and the Role of Preoperative Embolization in Hypervascular Skull Tumors. J Craniofac Surg 2016; 26:2289-92. [PMID: 26501975 DOI: 10.1097/scs.0000000000002218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Metastatic tumors are the most common cranial neoplasms in adults. Skull metastases from rare primary tumors, such as cholangiocarcinoma or pancreatic neuroendocrine tumor, are extremely uncommon and rarely reported. Given the scarcity and variation of these rare skull metastases, treatments and outcomes of such patients are of interest to treating surgeons. The authors describe the treatment algorithm, course, and outcomes of 2 patients with rare gastrointestinal skull metastases. The first patient had intrahepatic cholangiocarcinoma metastatic to the skull, while the second patient developed a solitary skull metastasis secondary to a pancreatic neuroendocrine tumor. As part of this report, the authors include a literature review of rare skull metastases as well as the treatment of these 2 patients. Both the patients ultimately underwent successful resection of the tumor for relief of their clinical symptoms. Wide resections in both patients necessitated reconstruction using a free latissimus dorsi muscle flap in both the patients. Preoperative embolization of the hypervascular cholangiocarcinoma skull metastasis was performed prior to resection in the first patient. To date, there have been only 4 such reports of skull metastases from intrahepatic cholangiocarcinoma and limited reported cases of isolated skull metastases from a pancreatic neuroendocrine tumor.In patients with large or numerous skull metastasis from rare primary tumors, surgical resection should be considered for symptomatic improvement. In cases of hypervascular lesions, preoperative embolization can be considered to decrease the intraoperative bleeding. Free tissue transfers using myocutaneous flaps such as latissimus dorsi help in obliterating dead space, and creating a healthy soft tissue envelope to withstand postoperative radiation treatment. In addition, a chimeric flap can be designed to include additional muscle or soft tissue to obliterate and exclude the sinus cavities.
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Lee TH, Rangan V, Khallafi H. A Case of Sphenoid Sinus Metastasis in Hepatocellular Carcinoma. Hepatology 2016; 63:2050-3. [PMID: 26928869 DOI: 10.1002/hep.28516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 02/02/2016] [Accepted: 02/18/2016] [Indexed: 12/07/2022]
Abstract
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).
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Affiliation(s)
- Tae Hoon Lee
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Vikram Rangan
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Hicham Khallafi
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
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22
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Kim YS, Moon KS, Lee KH, Jung TY, Jang WY, Kim IY, Jung S. Spontaneous acute epidural hematoma developed due to skull metastasis of hepatocelluar carcinoma: A case report and review of the literature. Oncol Lett 2016; 11:741-744. [PMID: 26870277 DOI: 10.3892/ol.2015.3947] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 10/23/2015] [Indexed: 01/30/2023] Open
Abstract
Acute epidural hematoma (AEDH) is one of the most common pathological types of head trauma, and may develop without an accidental event, although this is uncommon. The present study reports the case of a 41-year-old male patient that developed spontaneous AEDH due to skull metastasis of hepatocellular carcinoma (HCC). The man was admitted to Chonnam National University Hwasun Hospital and Medical School due to drowsiness and right-sided hemiparesis. A computed tomography scan of the head revealed the presence of a large AEDH and a lytic bone lesion in the left posterior fossa and parieto-occipital region, which exhibited heterogeneous enhancement. The perioperative findings revealed a large amount of mixed-stage epidural hematoma and a soft hemorrhagic mass that exhibited lytic change on the occipital bone. No evidence of head trauma, such as skull fracture or scalp contusion, was detected. The pathological diagnosis was hematoma with metastatic HCC. The current study reports the rare case of a patient with a metastatic tumor located in the skull that resulted in the development of spontaneous AEDH. Once a sudden and unpredicted neurological deficit occurs in a patient with HCC that is also diagnosed with skull metastasis, the possibility of spontaneous AEDH developing from the metastasis should be considered.
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Affiliation(s)
- You-Sub Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Woo-Youl Jang
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - In-Young Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam 519-763, Republic of Korea
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Liu M, Liu S, Liu B, Liu B, Guo L, Wang X, Wang Q, Yang S, Dong L. Bulbar Paralysis and Facial Paralysis due to Metastatic Hepatocellular Carcinoma: A Case Report and Literature Review. Medicine (Baltimore) 2016; 95:e2632. [PMID: 26825921 PMCID: PMC5291591 DOI: 10.1097/md.0000000000002632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Skull-base metastasis (SBM) from hepatocellular carcinoma (HCC) is extremely rare, and multiple cranial nerve paralysis due to SBM from HCC is also rare. We report a case of bulbar and facial paralysis due to SBM from HCC. A 46-year-old Chinese man presented with a hepatic right lobe lesion that was detected during a routine physical examination. After several failed attempts to treat the primary tumor and bone metastases, neurological examination revealed left VII, IX, X, and XI cranial nerve paralysis. Computed tomography of the skull base subsequently revealed a large mass that had destroyed the left occipital and temporal bones and invaded the adjacent structure. After radiotherapy (27 Gy, 9 fractions), the patient experienced relief from his pain, and the cranial nerve dysfunction regressed. However, the patient ultimately died, due to the tumor's progression. Radiotherapy is usually the best option to relieve pain and achieve regression of cranial nerve dysfunction in cases of SBM from HCC, although early treatment is needed to achieve optimal outcomes. The present case helps expand our understanding regarding this rare metastatic pathway and indicates that improved awareness of SBM in clinical practice can help facilitate timely and appropriate treatment.
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Affiliation(s)
- Min Liu
- From the Department of Radiation Oncology, The First Hospital, Jilin University, 71 Xinmin Street (ML, BL, QW, SY, LD); Department of Radiation Oncology, Tumor Hospital of Jilin Province, 1018 Huguang Road (SL); Department of Hand Surgery (BL); Department of Pathology (LG); and Department of Cancer Center, The First Hospital, Jilin University, 71 Xinmin Street, Changchun, China (XW)
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Multiple Bone Metastases as the First Manifestation of Hepatocellular Carcinoma in Patient with Noncirrhotic Liver. Case Rep Oncol Med 2015; 2015:512849. [PMID: 26635983 PMCID: PMC4655285 DOI: 10.1155/2015/512849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/24/2015] [Accepted: 10/27/2015] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) generally occurs on the background of chronic liver disease. Chronic hepatitides B and C and alcoholic liver disease are well-known risk factors for HCC, and it is uncommon in noncirrhotic liver. Extrahepatic metastasis seldom occurs in patients with early stage intrahepatic HCC and isolated bone metastases as a first documented extrahepatic metastasis is unusual presentation. In this report, we present a rare case of small solitary HCC (<3 cm) in noncirrhotic liver, presenting isolated bone metastases as a sole manifestation in patient with no well-known risk factors. This case suggests that HCC should be considered as one of differential diagnoses in patient presenting with multiple bone metastases, even in the absence of liver cirrhosis.
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25
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Yu WYH, Tierney LM. HCC without cirrhosis metastasizing to the clivus. Int Cancer Conf J 2015. [DOI: 10.1007/s13691-014-0195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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26
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Subasinghe D, Keppetiyagama CT, Sudasinghe H, Wadanamby S, Perera N, Sivaganesh S. Solitary scalp metastasis - a rare presentation of hepatocellular carcinoma. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2015; 9:4. [PMID: 26064186 PMCID: PMC4461905 DOI: 10.1186/s13022-015-0013-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 06/03/2015] [Indexed: 01/13/2023]
Abstract
Introduction Hepatocellular carcinoma (HCC) is among the commonest cancers in the world. Metastasis is one of the most significant factors affecting prognosis. Common sites of extrahepatic metastases include lungs, regional lymph nodes and less commonly bone. Case presentation A 56-year-old male presented with a painless occipital scalp lump of three months duration, with recent rapid enlargement. His skull x-ray showed a lytic lesion over occipital bone and the contrast CT scan of the brain showed a scalp mass with destruction of the adjacent skull. Core biopsy of the lesion revealed a metastatic deposit from a hepatocellular carcinoma. Conclusion Primary presentation with skeletal metastases are rare in HCC with only a few reported cases. Here we report a case of HCC presenting as a solitary scalp lump.
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Affiliation(s)
- Duminda Subasinghe
- University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Hemantha Sudasinghe
- University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Saman Wadanamby
- Department of Neurosurgery, The National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Niranthi Perera
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sivasuriya Sivaganesh
- University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka ; Department of Surgery, Faculty of Medicine, Kynsey Road, Colombo 8, Colombo, Sri, Lanka
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27
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Susheela SP, Revannasiddaiah S, Basavalingaiah AS, Madabhavi I. Painless lump over the forehead which turned painful: an unusual presentation of hepatocellular carcinoma. BJR Case Rep 2015; 1:20150033. [PMID: 30363169 PMCID: PMC6159124 DOI: 10.1259/bjrcr.20150033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/05/2015] [Accepted: 04/17/2015] [Indexed: 11/05/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies and is known to most often present with symptomatology pertaining to local hepatic disease. Although HCC is known to metastasize to lungs, abdominal lymph nodes, adrenal glands and the vertebral column, it is rather rare to come across patients with skull metastasis. The manifestation of a solitary frontal bone metastasis leading to a painless lump over the forehead as the initial presenting feature of HCC is highly unusual. This case report pertains to a 40-year-old male patient who had initially observed a painless lump over his forehead that was gradually increasing in size over a span of 3 months. He sought medical attention when, after several months, the “painless lump” suddenly became painful. Investigations revealed the involvement of both the outer and the inner table of the frontal bone, and a biopsy revealed the histopathology to be that of HCC. On further investigation, he was found to have systemic disseminated disease involving both the left and right lungs and vertebrae and treatment was initiated with sorafenib. Despite an initial partial response, the patient subsequently succumbed to hepatic failure. This case report illustrates the fact that HCC can silently progress, and even lead to dissemination and distant metastases before becoming clinically evident.
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Affiliation(s)
- S P Susheela
- Department of Radiation Oncology, HealthCare Global, -Bangalore Institute of Oncology, Bengaluru, India
| | - S Revannasiddaiah
- Department of Radiation Oncology, Government Medical College-Haldwani, Nainital, India.,0000-0001-6985-9874
| | - A S Basavalingaiah
- Department of Radiation Oncology, HealthCare Global, -Bangalore Institute of Oncology, Bengaluru, India
| | - I Madabhavi
- Department of Medical & Pediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, India
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28
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Chye CL, Lin KH, Ou CH, Sun CK, Chang IW, Liang CL. Acute spontaneous subdural hematoma caused by skull metastasis of hepatocellular carcinoma: case report. BMC Surg 2015; 15:60. [PMID: 25958386 PMCID: PMC4432998 DOI: 10.1186/s12893-015-0045-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/04/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Skull and intracranial metastases from hepatocellular carcinoma (HCC) have seldom been reported. A skull metastasis of HCC with a tumor bleeding resulting in spontaneous subdural hematoma (SDH) is extremely unusual. We report the first case of acute spontaneous SDH in a 69-year-old woman who presented with acute onset of headache, because of tumor bleeding caused by skull metastasis of HCC. CASE PRESENTATION A 69-year-old woman was referred to our hospital because of progressive headache, nausea, and vomiting for 3 days. Brain computed tomography (CT) performed in the emergency department (ED) revealed a left temporal SDH with a slight mass effect and a small left temporal bone erosion. Tri-phasic abdominal CT demonstrated a large right lobe liver tumor compatible with HCC. She experienced progressive deterioration of consciousness in the intensive care unit. Follow-up CT showed an enlargement of the SDH. An emergency craniotomy for hematoma evacuation and removal of skull tumor was performed. She regained consciousness and had no neurological deficits during the postoperative course. Pathological examination of the skull specimen indicated metastasis of a HCC. CONCLUSION Patients with acute SDH without a history of head injury are rarely encountered in the ED. Metastatic carcinoma with bleeding should be included as a differential diagnosis for acute spontaneous SDH. Before an operation for SDH, the possibility of metastatic lesion of the skull should be considered in the surgical planning and the origin of malignancy should be sought.
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Affiliation(s)
- Cien-Leong Chye
- Department of Neurosurgery, E-Da Hospital, School of Medicine, I-Shou University, 1 E-Da Rd., Yan-Chau Dist, 824, Kaohsiung City, Taiwan
| | - Kuo-Hsuan Lin
- Department of Emergency Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chang-Hsien Ou
- Department of Diagnostic Radiology, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - I-Wei Chang
- Department of Pathology, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheng-Loong Liang
- Department of Neurosurgery, E-Da Hospital, School of Medicine, I-Shou University, 1 E-Da Rd., Yan-Chau Dist, 824, Kaohsiung City, Taiwan.
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29
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Hayashi S, Tanaka H, Hoshi H. Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma. World J Hepatol 2014; 6:923-929. [PMID: 25544879 PMCID: PMC4269911 DOI: 10.4254/wjh.v6.i12.923] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 08/31/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
The incidence of bone metastases (BMs) from hepatocellular carcinoma (HCC) is relatively low compared to those of other cancers, but it has increased recently, especially in Asian countries. Typically, BMs from HCC appear radiologically as osteolytic, destructive, and expansive components with large, bulky soft-tissue masses. These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth. They often compress the peripheral nerves, spinal cord, or cranial nerves, causing not only bone pain but also neuropathic pain and neurological symptoms. In patients with spinal BMs, the consequent metastatic spinal cord compression (MSCC) causes paralysis. Skull base metastases (SBMs) with cranial nerve involvement can cause neurological symptoms. Therefore, patients with bony lesions often suffer from pain or neurological symptoms that have a severe, adverse effect on the quality of life. External-beam radiotherapy (EBRT) can effectively relieve bone pain and neurological symptoms caused by BMs. However, EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant studies. Furthermore, the optimal dosing schedule remains unclear, despite clinical evidence to support single-fraction radiation schedules for primary cancers. In this review, we outline data describing palliative EBRT for BMs from HCC in the context of (1) bone pain; (2) MSCC; and (3) SBMs.
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30
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Elian MMM, Gawad EAA. The many, atypical presentations of musculoskeletal hepatocellular carcinoma (HCC) metastases. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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31
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Kumar PM, Manisha M. Epidural hematoma secondary to solitary skull metastasis from an ovarian carcinoma. Asian J Neurosurg 2014; 9:112-4. [PMID: 25126131 PMCID: PMC4129576 DOI: 10.4103/1793-5482.136729] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We report a rare case of an acute epidural hematoma (EDH) due to solitary skull metastasis in a 60-year-old patient treated earlier for ovarian carcinoma. The patient presented with head injury followed by unconsciousness and computerized tomography showed a large EDH in the right parietal region along with a contusion of left temporal-parietal lobe and subarachnoid hemorrhage in left sylvian fissure. Emergency craniotomy and evacuation of the EDH was performed and the hemorrhage was determined to be secondary to skull metastasis of ovarian carcinoma; the patient recovered and received whole brain radiation therapy.
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Affiliation(s)
- P M Kumar
- Department of Neurosurgery, GSL Medical College, Rajahmundry, Andhra Pradesh, India
| | - M Manisha
- Department of Pathology, GSL Medical College, Rajahmundry, Andhra Pradesh, India
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Rouger C, N’Guyen Y, Bani-Sadr F. Une fausse pelade. Rev Med Interne 2014; 35:210-1. [DOI: 10.1016/j.revmed.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/04/2013] [Indexed: 11/24/2022]
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Guo X, Yin J, Jiang Y. Solitary skull metastasis as the first symptom of hepatocellular carcinoma: case report and literature review. Neuropsychiatr Dis Treat 2014; 10:681-6. [PMID: 24812512 PMCID: PMC4011926 DOI: 10.2147/ndt.s58059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Xieli Guo
- Department of Neurosurgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China ; Department of Neurosurgery, Jinjiang Hospital of Quanzhou Medical College, Jinjiang, Fujian, People's Republic of China
| | - Jiangliu Yin
- Department of Neurosurgery, Changsha Central Hospital, Changsha, Hunan, People's Republic of China
| | - Yugang Jiang
- Department of Neurosurgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
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34
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Chang CH, Chen CC, Tsai IT, Sun CK, Liang CL, Chang HC. Subdural hemorrhage from a hepatoma due to metastasis. J Acute Med 2013. [DOI: 10.1016/j.jacme.2013.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Wilson TC, Kirby PA. A 50-year-old man with back pain and a sellar mass. Metastatic hepatocellular carcinoma. Brain Pathol 2013; 23:365-6. [PMID: 23587145 DOI: 10.1111/bpa.12053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hepatocellular carcinoma rarely metastasizes to the pituitary gland and this site is very rarely the initial site of disease presentation. When it does, it may mimic a far more common pituitary adenoma. Metastatic hepatocellular carcinoma should be suspected in any individual with known liver disease or significant risk factors. The most common clinical sign of metastatic HCC to the skull is a subcutaneous mass followed by neurological deficits including visual disturbances, headache and seizure. The diagnosis can be made based on the histopathologic and immunohistochemical findings. When metastatic HCC is present in the skull base, appropriate work up should be done to rule out other metastatic sites, most commonly present in the spine.
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Affiliation(s)
- Thomas C Wilson
- University of Iowa Hospitals and Clinics, Department of Pathology, USA
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36
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Fujimoto K, Kuroda JI, Makino K, Hasegawa Y, Kuratsu JI. Skull metastasis from intrahepatic cholangiocarcinoma: report of 3 cases and review of the literature. Neurol Med Chir (Tokyo) 2013; 53:717-21. [PMID: 24077267 PMCID: PMC4508741 DOI: 10.2176/nmc.cr2012-0237] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Skull metastases occur in patients with various malignancies; however, those resulting from intrahepatic cholangiocarcinoma (ICC) have been rarely reported. In our hospital, 324 patients were diagnosed with metastatic brain or skull tumors from June 1969 to June 2011, but only 3 of them (0.9%) developed skull metastases from ICC. We report the case of 3 patients with skull metastases from ICC. A combination of computed tomography (CT), contrast-enhanced magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and methionine-PET were used for imaging. Sites of tumors were the lateral left orbit and right parietal bone in case 1, the left parietal bone, left temporal bone, and lateral left orbit in case 2, the right petrous bone, right occipital bone, and upper cervical vertebra in case 3. The metastases were confirmed to have originated from ICC by biopsy in two of the cases and diagnosed by MRI and FDG-PET in case 2. Radiosurgery and radiotherapy had positive effects on symptom improvement and cosmetic problems.
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Affiliation(s)
- Kenji Fujimoto
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine
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Tamura T, Kawamura Y, Ikeda K, Seko Y, Fukushima T, Kumada H, Yamada S, Matumaru Y. Hepatocellular carcinoma metastasis to the brain mimicking primary pituitary tumor around the sella turcica. Clin J Gastroenterol 2013; 6:319-25. [PMID: 26181737 DOI: 10.1007/s12328-013-0384-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
We report on two cases of hepatocellular carcinoma (HCC) with metastasis to the cavernous sinus and sphenoid sinus. Both cases presented with diplopia and retro-orbital headache and both underwent surgery for a primary pituitary gland tumor. After surgery, both cases were diagnosed with metastases from HCC. Case 1 was a 67-year-old male with a history of HCC who was referred to our hospital for pituitary tumor surgery. The tumor appeared to be in the sella turcica and to invade the sphenoid sinus and right cavernous sinus. Transnasal transsphenoidal surgery (TSS) was performed. The tumor was postoperatively diagnosed by histology to be a metastatic pituitary tumor from HCC. Radiotherapy was administered to the metastatic site. Case 2 was a 58-year-old male with a history of TSS for a pituitary tumor 16 years previously. He was referred to our hospital for TSS for a recurrent pituitary adenoma. TSS was performed twice in 3 months. During a preoperative general examination, HCC and chronic hepatitis B were revealed. TSS was performed initially, followed by arterial infusion chemotherapy. After TSS, the pituitary tumor was diagnosed by histology to be a metastasis from HCC. As with Case 1, radiotherapy was administered to the metastasis. Most tumors in the sella turcica are pituitary adenomas, although some cases of metastatic pituitary tumors and skull base metastases have been reported. Distant metastases generally have a poor prognosis; however, surgery to the metastatic site can effectively control symptoms caused by the metastatic tumor.
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Affiliation(s)
- Tetsuo Tamura
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan.
| | - Yusuke Kawamura
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan
| | - Kenji Ikeda
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan.,Okinaka Medical Institute for Medical Research, Tokyo, Japan
| | - Yuya Seko
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan
| | - Taito Fukushima
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan
| | - Hiromitu Kumada
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan.,Okinaka Medical Institute for Medical Research, Tokyo, Japan
| | - Shozo Yamada
- Department of Neurosurgery, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan.,Okinaka Medical Institute for Medical Research, Tokyo, Japan
| | - Yuji Matumaru
- Department of Endovascular Neurosurgery, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan. .,Okinaka Medical Institute for Medical Research, Tokyo, Japan.
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Azarpira N, Dehghanian A, Safarian A, Kazemi K. Case report of skull metastasis from hepatocellular carcinoma after a liver transplant. EXP CLIN TRANSPLANT 2013; 12:265-8. [PMID: 23745813 DOI: 10.6002/ect.2013.0019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A solitary skull metastasis from hepatocellular carcinoma is rare. A 38-year-old man with hepatocellular carcinoma presented to our institution with a palpable temporal scalp mass. We took a magnetic resonance image, and discovered an enhanced and osteolytic skull tumor. The tumor was removed by an occipital craniectomy, and the histologic diagnosis was a cranial metastasis owing to hepatocellular carcinoma. A skull metastasis owing to hepatocellular carcinoma should be considered in the differential diagnosis in patients with a subcutaneous scalp mass. Although a distant metastasis can affect the prognosis of the patient, early treatment may improve survival.
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Affiliation(s)
- Negar Azarpira
- Transplant Research Center, Department of Pathology, Shiraz University of Medical Science, Shiraz, IR Iran
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Brunetti AE, Popescu O, Silvestris N. Synchronous mandibular and giant parieto-occipital skull metastasis from hepatocellular carcinoma. Clin Gastroenterol Hepatol 2013; 11:xxvi. [PMID: 22935266 DOI: 10.1016/j.cgh.2012.08.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 08/07/2012] [Accepted: 08/09/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Anna Elisabetta Brunetti
- Medical and Experimental Oncology Unit, National Cancer Institute Giovanni Paolo II, Bari, Italy
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Zachau L, Zeckey C, Schlue J, Sander J, Meyer-Heithuis C, Winkler M, Klempnauer J, Schrem H. Haematogenous abdominal wall metastasis of differentiated, alpha-fetoprotein-negative hepatocellular carcinoma after previous antiandrogen therapy within a site of lipoma manifestation since childhood. World J Surg Oncol 2012; 10:98. [PMID: 22647077 PMCID: PMC3408335 DOI: 10.1186/1477-7819-10-98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/30/2012] [Indexed: 02/06/2023] Open
Abstract
Background Cases with subcutaneous metastasis of differentiated hepatocellular carcinoma to the abdominal wall without prior seeding as a consequence of local interventions with a negative or normal alpha-fetoprotein level in the serum are extremely rare. Case report This is the first report of a case with AFP-negative, differentiated hepatocellular carcinoma metastasis to the abdominal wall within a pre-existing subcutaneous lipoma since childhood after antiandrogen therapy with leuprorelin and buserelin acetate for prostate cancer without seeding. Methods Clinical features including histology, immunohistochemistry, clinical course and surgical approach are presented. Results Histological examination revealed a hepatocellular carcinoma with a trabecular and pseudoglandular growth pattern with moderately atypical hepatocytes with multifocal bile formation within a lipoma. The postoperative course of abdominal wall reconstruction with a monocryl-prolene mesh and a local flap after potentially curative resection was uncomplicated. Discussion and conclusion It may be that previous antiandrogen treatment for prostate carcinoma contributed to the fact that our patient developed alpha-fetoprotein-negative and androgen receptor-negative subcutaneous abdominal wall metastasis within a pre-existing lipoma since childhood.
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Affiliation(s)
- L Zachau
- General, Visceral und Transplantation Surgery, Hanover Medical School, Carl-Neuberg-Str, 1, 30625, Hannover, Germany
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41
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Sánchez-Delgado J, Calzado S, de Haro C, Mas M, Miquel M, Casas M, Vergara M, Dalmau B, Gil M. [Long survival after resection of cranial metastases from hepatocellular carcinoma. Case report and review of the literature]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 35:12-6. [PMID: 22177938 DOI: 10.1016/j.gastrohep.2011.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 10/22/2011] [Accepted: 11/06/2011] [Indexed: 01/08/2023]
Abstract
The life expectancy of patients with hepatocellular carcinoma (HCC) has increased in the last few years due to recent treatment advances. However, extrahepatic metastases from tumors, previously described only occasionally, are becoming more frequent in clinical practice. The choice between an active or passive approach to these metastatic lesions can sometimes present clinicians with a difficult dilemma. We discuss the case of a male patient with multifocal HCC and cranial metastasis from a primary liver tumor and who, after surgery and radiotherapy over the metastatic lesion, has survived for more than 3 years.
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Affiliation(s)
- Jordi Sánchez-Delgado
- Unidad de Hepatología, Servicio de Aparato Digestivo, Universitat Autònoma de Barcelona, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
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42
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Ito J, Saito T, Iwaba A, Suzuki Y, Sanjo M, Ishii R, Sato C, Haga H, Okumoto K, Nishise Y, Watanabe H, Saito K, Togashi H, Kawata S. A case of monocular blindness as the initial presentation of hepatocellular carcinoma with skull metastasis. Clin J Gastroenterol 2011; 4:273-277. [PMID: 26189533 DOI: 10.1007/s12328-011-0237-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 06/14/2011] [Indexed: 12/14/2022]
Abstract
A 52-year-old man suffering from monocular blindness, with light perception only, was admitted to our hospital. The symptom had begun as low vision and developed rapidly within 3 weeks into monocular blindness in the right eye, with no other systemic manifestations. Imaging examinations revealed multiple hepatocellular carcinomas in the cirrhotic liver, and tumors at the skull base and vertebra. A pathological and immunochemical study of specimens obtained by endoscopic transnasal tumor biopsy and laminectomy revealed them to be metastatic hepatocellular carcinomas (HCCs). Although the patient underwent radiation therapy and chemotherapy, he died 5 months after admission to our hospital. The cranial HCC, involving only the optic canal, may have disturbed the optic nerve in preference to the other cranial nerves. This is the first report of a HCC patient with monocular blindness as the initial presentation of the disease.
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Affiliation(s)
- Junitsu Ito
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Takafumi Saito
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Akiko Iwaba
- Department of Diagnostic Pathology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Yoshihiro Suzuki
- Department of Gastroenterology, Nihonkai General Hospital, 30 Akiho-cho, Sakata, Yamagata, 998-8501, Japan
| | - Mai Sanjo
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Rika Ishii
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Chikako Sato
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hiroaki Haga
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Kazuo Okumoto
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Yuko Nishise
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hisayoshi Watanabe
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Koji Saito
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hitoshi Togashi
- Health Administrative Center, Yamagata University, 1-4-12 Kojirakawa, Yamagata, 990-9560, Japan
| | - Sumio Kawata
- Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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Woo KM, Kim BC, Cho KT, Kim EJ. Spontaneous epidural hematoma from skull base metastasis of hepatocellular carcinoma. J Korean Neurosurg Soc 2010; 47:461-3. [PMID: 20617094 DOI: 10.3340/jkns.2010.47.6.461] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 12/04/2009] [Accepted: 05/17/2010] [Indexed: 01/30/2023] Open
Abstract
We report a case of an acute spontaneous epidural hematoma (EDH) due to skull base metastasis in a 46-year-old male patient with hepatocellular carcinoma (HCC). The patient presented with the acute onset of severe headache followed by unconsciousness, and computed tomography showed a large EDH in the right temporal and parietal lobes with midline shift. Emergency evacuation of the EDH was performed, and the hemorrhage was determined to be secondary to skull base metastasis of HCC.
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Affiliation(s)
- Kwang Moo Woo
- Department of Neurosurgery, Dongguk University College of Medicine, Dongguk University International Hospital, Goyang, Korea
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Goto T, Dohmen T, Miura K, Ohshima S, Yoneyama K, Shibuya T, Kataoka E, Segawa D, Sato W, Anezaki Y, Ishii H, Kon D, Yamada I, Kamada K, Ohnishi H. Skull metastasis from hepatocellular carcinoma with chronic hepatitis B. World J Gastrointest Oncol 2010; 2:165-8. [PMID: 21160825 PMCID: PMC2999177 DOI: 10.4251/wjgo.v2.i3.165] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 10/26/2009] [Accepted: 11/02/2009] [Indexed: 02/05/2023] Open
Abstract
A 56-year-old male visited our hospital for evaluation of an occipital mass. Contrast computed tomography showed hypervascular enhancement with osteolytic change in the skull and a huge enhanced mass in the liver. Magnetic resonance imaging showed bone metastasis in the thoracic vertebrae. Assays for hepatitis B surface antigen and hepatitis B core antibody were positive and his liver condition was Child-Pugh grade A. Our diagnosis was hepatocellular carcinoma (HCC) with skull and vertebrae metastases on chronic hepatitis B. He was treated with radiation therapy for bone metastases and transcatheter arterial chemoembolization for HCC. But he developed acute respiratory failure because of aspiration pneumonia, congestion and oedema with haemorrhage of the lungs and died. Dissection showed HCC with multiple bone metastases. The liver tumor was categorized as well-differentiated HCC, Edmondson classification I, trabecular type and pseudoglandular type. In the liver mild infiltration of lymphocytes was seen in Glisson’s capsules which were significantly enlarged with well preserved limiting plates. Piecemeal necrosis was not obvious. No fibrosis was noted. An 8 cm × 7 cm × 3 cm metastatic lesion had formed in the left occipitotemporal part of the cranial bone. The lesion was osteolytic and showed invasion into the dura mater. Neither the subdural cavity nor the brain showed involvement from the metastatic tumor. However, skull metastasis from HCC is very rare and it affects the patient’s prognosis and the quality of life. Therefore, it is very important to make an early diagnosis and carry out proper management of skull metastasis from HCC.
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Affiliation(s)
- Takashi Goto
- Takashi Goto, Takahiro Dohmen, Kouichi Miura, Shigetoshi Ohshima, Kazuo Yoneyama, Tomomi Shibuya, Ei Kataoka, Daisuke Segawa, Wataru Sato, Yumiko Anezaki, Hajime Ishii, Daigo Kon, Ikuhiro Yamada, Kentaro Kamada, Hirohide Ohnishi, Department of Gastroenterology, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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Nozaki I, Tsukada T, Nakamura Y, Takanaka T, Yamada M. Multiple skull metastases from hepatocellular carcinoma successfully treated with radiotherapy. Intern Med 2010; 49:2631-4. [PMID: 21139306 DOI: 10.2169/internalmedicine.49.4236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
We report a Japanese man who presented with multiple cranial nerve palsies with hepatitis B virus-related multiple hepatocellular carcinoma (HCC). He presented with right III, IV, VI, IX, X, and XII cranial nerve palsies. Metastases involving the clivus and the right occipital bone from HCC were diagnosed by the findings of magnetic resonance imaging of the head, cerebral angiography, and 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/computed tomography. In this case, over one-year survival and improvement of neurological signs were achieved by radiotherapy in spite of multiple skull metastases, which are extremely rare.
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Affiliation(s)
- Ichiro Nozaki
- Department of Neurology, Noto General Hospital, Nanao.
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46
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Trivedi P, Gupta A, Pasricha S, Agrawal G, Shah M. Isolated skull base metastasis as the first manifestation of hepatocellular carcinoma--a rare case report with review of literature. J Gastrointest Cancer 2009; 40:10-4. [PMID: 19705301 DOI: 10.1007/s12029-009-9081-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 08/10/2009] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- Priti Trivedi
- Department of Pathology, The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India.
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Kanai R, Kubota H, Terada T, Hata T, Tawaraya E, Fujii K. Spontaneous epidural hematoma due to skull metastasis of hepatocellular carcinoma. J Clin Neurosci 2008; 16:137-40. [PMID: 19013817 DOI: 10.1016/j.jocn.2008.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 02/16/2008] [Accepted: 02/19/2008] [Indexed: 01/12/2023]
Abstract
Although "spontaneous" epidural hematomas are rare, they can occur in patients with metastatic skull tumors. We describe a case caused by skull metastasis of hepatocellular carcinoma (HCC), and review the relevant literature. In patients with HCC, potential skull metastasis should be kept in mind, since skull metastases from HCC seem to often cause devastating epidural hematoma.
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Affiliation(s)
- Ryuichi Kanai
- Department of Neurosurgery, Shizuoka City Shimizu Hospital, Shimizu-Miyakami 1231, 424-8636 Shizuoka, Japan.
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Shim YS, Ahn JY, Cho JH, Lee KS. Solitary skull metastasis as initial manifestation of hepatocellular carcinoma. World J Surg Oncol 2008; 6:66. [PMID: 18570669 PMCID: PMC2467423 DOI: 10.1186/1477-7819-6-66] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 06/21/2008] [Indexed: 11/25/2022] Open
Abstract
Background A solitary skull metastasis from hepatocellular carcinoma (HCC) prior to diagnosis of the primary tumor without liver dysfunction is a very rare event. Case presentation A 71-year-old male, without known liver disease, presented to our institution with a palpable occipital scalp mass. On brain magnetic resonance imaging (MRI), a highly enhanced and osteolytic skull tumor was observed. The histological diagnosis obtained from the percutaneous needle biopsy was a cranial metastasis from HCC. The metastatic tumor was removed via occipital craniectomy, and the two primary liver mass lesions were subsequently treated by transarterial chemoembolization. Conclusion An isolated skull metastasis may be the sole initial presentation of HCC. Early diagnosis is essential in order to treat the primary disease. A skull metastasis from HCC should be considered in the differential diagnosis in patients with subcutaneous scalp mass and osteolytic defects on X-ray.
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Affiliation(s)
- Yu Shik Shim
- Department of Neurosurgery, Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea.
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