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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Distant metastasis of hepatocellular carcinoma to Meckel’s cave and cranial nerves: A case report and review of literature
Soo Ki Kim, Takako Fujii, Ryouhei Komaki, Hisato Kobayashi, Toyokazu Okuda, Yumi Fujii, Takanobu Hayakumo, Kanako Yuasa, Masahiro Takami, Aya Ohtani, Yuka Saijo, Yu-Ichiro Koma, Soo Ryang Kim
Soo Ki Kim, Takako Fujii, Toyokazu Okuda, Yumi Fujii, Takanobu Hayakumo, Kanako Yuasa, Masahiro Takami, Soo Ryang Kim, Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
Ryouhei Komaki, Division of Neurology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
Hisato Kobayashi, Department of Radiology, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
Aya Ohtani, Yuka Saijo, Department of Pharmacy, Kobe Asahi Hospital, Kobe 653-0801, Hyogo, Japan
Yu-Ichiro Koma, Department of Pathology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
Author contributions: Kim SK conceived the case and wrote the manuscript; Kim SR and Komaki R observed the clinical course of the patient and made the figures; Fujii T, Okuda T, Fujii Y, Hayakumo T, Yuasa K, Takami M, Ohtani A and Saijo Y observed the clinical course of the patient; Kobayashi H conducted the radiological examinations and interpreted the imaging findings; Koma YI conducted histological examinations.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Takako Fujii, MD, PhD, Doctor, Department of Gastroenterology, Kobe Asahi Hospital, 3-5-25 Bououji-cho, Nagata-ku, Kobe 653-0801, Hyogo, Japan. kytacako@gmail.com
Received: February 17, 2021
Peer-review started: February 17, 2021
First decision: March 16, 2021
Revised: March 29, 2021
Accepted: June 16, 2021
Article in press: June 16, 2021
Published online: June 27, 2021
BACKGROUND
Metastasis occurs as a late event in the natural history of hepatocellular carcinoma (HCC), and most patients die of liver failure attributed to the tumor supplanting the liver. Conversely, the brain is a less common metastatic site.
CASE SUMMARY
We describe a rare case of hepatitis C virus-related multiple HCC metastasizing to the cavernous sinus, Meckel’s cave, and the petrous bone involving multiple cranial nerves in an 82-year-old woman. At admission imaging studies including Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (MRI) revealed multiple HCC nodules in both right and left lobes. Ultrasound guided biopsy of the left lobe revealed moderately differentiated HCC. Molecular targeted therapy with Lenvatinib (8 mg/d for 94 d, per os) and Ramucirumab (340 mg/d and 320 mg/d, two times by intravenous injection) were administered for 4 mo, resulting in progression of the disease. Three months after the start of molecular target therapy, the patient presented with symptoms of hyperalgesia of the right face and limited abduction of the right eye, indicating disturbances in the right trigeminal and abducens nerves. Brain MRI disclosed a mass involving the cavernous sinus, Meckel’s cave and the petrous bone. Contrast-enhanced MRI with gadolinium-chelated contrast medium revealed a well-defined mass with abnormal enhancement around the right cavernous sinus and the right Meckel’s cave.
CONCLUSION
The diagnosis of metastatic HCC to the cavernous sinus, Meckel’s cave, and the petrous bone was made based on neurological findings and imaging studies including MRI, but not on histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.
Core Tip: We describe a case of hyperalgesia of the right side of the face and limited abduction of the right eye caused by hepatocellular carcinoma (HCC) metastasizing to the right cavernous sinus, the right Meckel’s cave, and the right petrous bone diagnosed through neurological findings and imaging studies. Although HCC metastasizing to the cavernous sinus, Meckel’s cave and the petrous bone is rare, clinicians need to be vigilant when the patients show neurological dysfunction, especially cranial nerve involvement.
