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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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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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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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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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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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