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1
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Chen JW, Giridharan N, Kavoussi AA, Van Arsdale D, Hosseingholi Nouri S, Nitturi V, Trudeau T, Mandel JJ, Lu HC, Patel AJ. Isolated calvarial lesion as the initial presentation of metastatic hepatocellular carcinoma: A case report and review of the literature. Surg Neurol Int 2025; 16:6. [PMID: 39926447 PMCID: PMC11799690 DOI: 10.25259/sni_507_2024] [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: 06/25/2024] [Accepted: 11/20/2024] [Indexed: 02/11/2025] Open
Abstract
Background Hepatocellular carcinoma (HCC) contributes significantly to global cancer-related mortality, often because patients present at advanced stages of the disease. HCC commonly metastasizes to the lung, abdominal lymph nodes, and bone. However, even among bony metastases, calvarial lesions are exceptionally rare, especially in the initial presentation. Case Description We describe a unique case of a 65-year-old African American woman who presented with a rapidly growing skull lesion as her first clinical sign of metastatic HCC. Imaging revealed an extensive soft-tissue mass involving the left calvaria and partially obstructing the superior sagittal sinus. We suspected that the lesion was a meningioma and offered surgery. Histological examination and further systemic workup later confirmed HCC. She was started on adjuvant therapy but unfortunately deteriorated from complications secondary to disease progression. We also reviewed the literature on cases of isolated calvarial metastases as the initial presentation of HCC. A total of 36 case reports were reviewed which included 38 patients. There were 32 males (84.2%), and the mean age was 58.97 ± 9.09 years old. The most common location of presentation was the parietal or occipital region (13, 34.2%), and 18 patients (47.4%) underwent neurosurgical treatment of the lesion. Among the 26 cases that had a follow-up, 84.6% (n = 22) did not survive treatment, and the mean survival time was 6.15 ± 5.94 months. Conclusion Isolated calvarial lesions are rarely the initial presenting sign of metastatic HCC. Often, these lesions may be misdiagnosed as benign tumors, such as meningiomas or hemangiopericytomas, given their appearance on imaging. However, early identification of HCC skull lesions is crucial to initiating treatment, including resection, radiation, and immunotherapy, which may help improve symptoms and extend survival. Our case report adds to the limited literature on this exceedingly rare entity.
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Affiliation(s)
- Jeffrey Wu Chen
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Nisha Giridharan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Arman A. Kavoussi
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Dawn Van Arsdale
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | | | - Vijay Nitturi
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Trevor Trudeau
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Jacob J. Mandel
- Department of Neurology, Baylor College of Medicine, Houston, Texas, United States
| | - Hsiang-Chih Lu
- Department of Pathology, Baylor College of Medicine, Houston, Texas, United States
| | - Akash J. Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
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2
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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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3
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Lv GZ, Li GC, Tang WT, Zhou D, Yang Y. Spontaneous acute epidural hematoma secondary to skull and dural metastasis of hepatocellular carcinoma: A case report. World J Clin Cases 2022; 10:8728-8734. [PMID: 36157807 PMCID: PMC9453350 DOI: 10.12998/wjcc.v10.i24.8728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/12/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The skull and dura are uncommon sites for the metastasis of hepatocellular carcinoma (HCC). Spontaneous acute epidural hematoma (AEDH) is also very rare. We report here a spontaneous AEDH secondary to skull and dural metastasis of HCC. This case is extremely rare.
CASE SUMMARY A 48-year-old male patient with a history of HCC developed unconsciousness spontaneously. Head computed tomography showed "a huge AEDH in the left parietal and occipital region with osteolytic destruction of the left parietal bone. Emergent operation was performed to evacuate the hematoma and resect the lesion. Pathological study revealed that the lesion was the metastases from HCC. The patient died of lung infection, anemia, and liver failure 3 wk after operation.
CONCLUSION Spontaneous AEDH caused by hepatocellular carcinoma (HCC) dural and skull metastases is extremely rare, the outcome is poor. So, early diagnosis is important. If the level of AFP does not decrease with the shrinkage of intrahepatic lesions after treatment, it is necessary to be alert to the existence of extrahepatic metastases. Since most of the patients had scalp and bone masses, physicians should pay attention to the patient's head palpation. Once a patient with the history of HCC had sudden neurological dysfunction, the possibility of spontaneous AEDH caused by the skull and dura mater metastases should be considered. Since hemorrhage is common in the skull HCC metastases, for patients with spontaneous AEDH accompanied by skull osteolytic lesions, it is also necessary to be alert to the possibility of HCC. For AEDH secondary to HCC metastases, early diagnosis and timely treatment are critical to improve the patients’ outcomes.
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Affiliation(s)
- Guang-Zhao Lv
- Department of Neurosurgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Guo-Chao Li
- Department of Neurosurgery, Luoding People’s Hospital, Yunfu 527200, Guangdong Province, China
| | - Wei-Tai Tang
- Department of Neurosurgery, Luoding People’s Hospital, Yunfu 527200, Guangdong Province, China
| | - Dong Zhou
- Department of Neurosurgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | - Yong Yang
- Department of Neurosurgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
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4
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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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5
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Cholangiocarcinoma Metastasis to the Spine and Cranium. Ochsner J 2020; 20:197-203. [PMID: 32612476 PMCID: PMC7310165 DOI: 10.31486/toj.18.0142] [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] [Indexed: 11/22/2022] Open
Abstract
Background: Cholangiocarcinoma (CCC), a rare tumor arising from the viscera, has a poor prognosis. Although CCC is prone to metastasis, spread to the cranium and spine is exceedingly rare. Treatment for metastatic disease is palliative, with total resection of the primary lesion the only cure. We describe a case of metastatic CCC to the spine and cranium treated with surgical resection. Case Report: A 61-year-old male with a history of hepatitis C with liver transplant and incidental discovery of CCC presented with gradually increasing back pain. Physical examination revealed a palpable nontender mass in the parieto-occipital area. Computed tomography survey of the spine and head revealed mixed sclerotic and lytic lesions of the T9, T11, L2, and L5 vertebral bodies, a lytic lesion on the T6 vertebral body, and a 1.4-cm lesion in the right occipital calvarium. The patient underwent right occipital craniotomy for excisional biopsy of the calvarial mass with gross total resection and immunohistochemical confirmation of CCC. The patient was started on gemcitabine chemotherapy and radiation therapy for spinal metastases. Three months later, the patient died from metastatic disease complications. Conclusion: To our knowledge, only 6 cases of cranial CCC have been reported, and only 2 reported mixed cranial/spinal involvement. We report a rare case of CCC metastasis to the spine and cranium that was treated with surgery, chemotherapy, and radiotherapy. CCC should be considered an exceedingly rare etiology with treatment options aimed solely at palliation. This case supplements the existing literature to inform medical and surgical decision-making.
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6
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Benevento I, DE Felice F, Bulzonetti N, Caiazzo R, Cassese R, Musio D, Tombolini V. Successful Treatment of Anal Canal Cancer Metastasis to the Cranial Bones: A Case Report and Literature Review. In Vivo 2019; 33:1347-1353. [PMID: 31280229 DOI: 10.21873/invivo.11610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/10/2022]
Abstract
Single metastasis to the cranial bone represents a very uncommon occurrence that can arise from an anal canal cancer. No cases of cranial bone metastasis from anal canal carcinoma are available in the literature. Herein, we present a case of a unique metastatic lesion to the right parietal bone that occurred after curative chemoradiotherapy of primary squamous cell anal canal carcinoma. The patient received radiotherapy and systemic platinum-based chemotherapy, with optimal local control, high compliance and a well tolerable level of toxicity.
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Affiliation(s)
- Ilaria Benevento
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Francesca DE Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Nadia Bulzonetti
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Rossella Caiazzo
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Raffaele Cassese
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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7
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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: 0.1] [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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8
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Sartori Balbinot R, Facco Muscope AL, Dal Castel M, Sartori Balbinot S, Angelo Balbinot R, Soldera J. Intraparenchymal Hemorrhage due to Brain Metastasis of Hepatocellular Carcinoma. Case Rep Gastroenterol 2017; 11:516-525. [PMID: 29033772 PMCID: PMC5637007 DOI: 10.1159/000479221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/05/2017] [Indexed: 01/07/2023] Open
Abstract
Although extrahepatic metastases from hepatocellular carcinoma (HCC) are present in only 5-15% of cases, they are certainly factors associated with poor prognosis. The main sites include lung, lymph nodes, bones, and adrenal glands, in descending order. Metastasis in the central nervous system is extremely rare, and the incidences vary from 0.6 to 1.7%. We report a case of a 54-year-old man previously diagnosed with alcohol-induced cirrhosis of the liver and HCC. The patient was admitted presenting progressive left hemiparesis and headache which started 2 days earlier, with no history of cranioencephalic trauma. After admission, cranial computed tomography revealed an intraparenchymal hemorrhage area with surrounding edema in the right frontal lobe. An angioresonance requested showed a large extra-axial mass lesion located in the right frontal region with well-defined contours and predominantly hypointense signal on T2 sequence. At first, the radiological findings suggested meningioma as the first diagnostic hypothesis. However, the patient underwent surgery. The tumor was completely removed, and the morphological and immunohistochemical findings were consistent with metastatic hepatocarcinoma associated with meningioma. In postoperative care, the patient did not recover from the left hemiparesis and manifested Broca's aphasia. He had a survival time of 24 weeks, presenting acute liver failure as his cause of death. There is a lack of evidence supporting a specific management of patients with brain metastasis from HCC. Furthermore, there are no studies that evaluate different modalities of therapeutics in brain metastasis of HCC due to the rarity of this condition. Therefore, management must be individualized depending on probable prognostic factors in these patients.
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Affiliation(s)
| | | | - Mateus Dal Castel
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Silvana Sartori Balbinot
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil
- Clinical Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Raul Angelo Balbinot
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil
- Clinical Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Jonathan Soldera
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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9
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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: 1.7] [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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10
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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: 1.0] [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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11
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Jang SY, Kim CH, Cheong JH, Kim JM. Concomitant Subdural Hemorrhage and Intracerebral Hemorrhage due to Brain Metastasis of the Hepatocellular Carcinoma. Brain Tumor Res Treat 2015; 3:48-51. [PMID: 25977908 PMCID: PMC4426278 DOI: 10.14791/btrt.2015.3.1.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/06/2014] [Accepted: 12/17/2014] [Indexed: 01/30/2023] Open
Abstract
Hemorrhagic metastatic brain tumors of hepatocellular carcinoma (HCC) are rare and have been mostly presented as intracranial hemorrhage (ICH). A 51-year-old male patient presented with sudden altered level of consciousness. He suffered from HCC since 2010 and transarterial chemoembolization was performed three times for HCC. The brain computed tomography (CT) scans revealed subdural hematoma (SDH) in the right fronto-temporal area and 6.0×3.5 cm sized ICH in the right parieto-occipital lobe. Brain angiographic CT scans demonstrated that the hemorrhagic lesions did not include any enhancing lesions and vascular abnormalities. We undertook a decompressive craniectomy and evacuation of the acute SDH and ICH. During evacuation of ICH, the yellowish mass was observed in the cortical surface of the right occipital lobe. Pathological examination displayed the findings of metastatic brain tumor from HCC. Metastatic brain tumors should be considered in the differential diagnosis as a cause of spontaneous SDH with ICH.
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Affiliation(s)
- Se Youn Jang
- Department of Neurosurgery, Seoul Medical Center, Seoul, Korea
| | - Choong Hyun Kim
- Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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12
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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: 15] [Impact Index Per Article: 1.4] [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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13
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Kim BG, Yoon SM, Bae HG, Yun IG. Spontaneous intracranial epidural hematoma originating from dural metastasis of hepatocellular carcinoma. J Korean Neurosurg Soc 2010; 48:166-9. [PMID: 20856668 DOI: 10.3340/jkns.2010.48.2.166] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 02/26/2010] [Accepted: 08/03/2010] [Indexed: 12/12/2022] Open
Abstract
Spontaneous intracranial epidural hematoma (EDH) due to dural metastasis of hepatocellular carcinoma is very rare. A 53-year-old male patient with hepatocellular carcinoma, who was admitted to the department of oncology, was referred to department of neurosurgery because of sudden mental deterioration to semicoma with papillary anisocoria and decerebrate rigidity after transarterial chemoembolization for hepatoma. Brain computed tomography (CT) revealed large amount of acute EDH with severe midline shifting. An emergent craniotomy and evacuation of EDH was performed. Active bleeding from middle cranial fossa floor was identified. There showed osteolytic change on the middle fossa floor with friable mass-like lesion spreading on the overlying dura suggesting metastasis. Pathological examination revealed anaplastic cells with sinusoidal arrangement which probably led to spontaneous hemorrhage and formation of EDH. As a rare cause of spontaneous EDH, dural metastasis from malignancy should be considered.
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Affiliation(s)
- Byoung-Gu Kim
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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14
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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: 22] [Impact Index Per Article: 1.5] [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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15
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Hassan MF, Dhamija B, Palmer JD, Hilton D, Adams W. Spontaneous cranial extradural hematoma: case report and review of literature. Neuropathology 2008; 29:480-4. [PMID: 19019180 DOI: 10.1111/j.1440-1789.2008.00977.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extradural hematoma (EDH) is usually a post-traumatic sequel but a few cases of spontaneous EDH have been reported. Here we report a woman who presented with spontaneous acute EDH but was later found to have dural metastasis from lung carcinoma. Causal factors have been present in all reported cases, as well as in this case. We propose the term non-traumatic EDH.
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Affiliation(s)
- Md Faizul Hassan
- South West Neurosurgical Centre, Derriford Hospital, Plymouth, UK.
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16
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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: 0.6] [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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17
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Abstract
The skull may be a site of metastasis in malignancies such as carcinoma of the breast, prostate, lung, and multiple myeloma. The majority of patients with skull metastases are asymptomatic or present with localized swelling which is often painless. While subdural hematoma has been commonly associated with metastatic disease involving the dura, hemorrhage from a skull
metastasis remains a rare occurrence. We present the case of acute epidural hematoma resulting from metastatic esophageal carcinoma to the skull.
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18
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Hsieh CT, Sun JM, Tsai WC, Tsai TH, Chiang YH, Liu MY. Skull metastasis from hepatocellular carcinoma. Acta Neurochir (Wien) 2007; 149:185-90. [PMID: 17180305 DOI: 10.1007/s00701-006-1071-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 10/25/2006] [Indexed: 12/25/2022]
Abstract
Metastasis to the skull frequently occurs in patients with lung, breast and prostate cancer. However, skull metastases from hepatocellular carcinoma (HCC) have been rarely reported. We review the literature on skull metastasis from HCC and report a case of a 46-year-old male, who was diagnosed as HCC and was operated on by trans-arterial embolization and lobectomy in Oct. 2004. He complained of a painless mass over the left frontal region for two months. Radiograph of the skull revealed an osteolytic mass about 4-5 cm in size over the left frontal region. A cranial computerized tomography demonstrated a destructive lesion with soft tissue mass over the left frontal region. A left frontal craniectomy was performed and tumor was totally removed. The histological diagnosis was cranial metastasis from HCC. Postoperative recovery was uneventful without any neurological deficits. Because of improved and advancing treatment for HCC, survival time for HCC has been lengthened and distant metastases will thus be found to increase. Early diagnosis is essential to treat the primary disease. Skull metastases from HCC should be considered as a differential diagnosis in patients with scalp subcutaneous mass and osteolytic defect on X-ray skull films.
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Affiliation(s)
- C-T Hsieh
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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19
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Miyamoto J, Tatsuzawa K, Sasajima H, Mineura K. Metastatic Skull Tumor From Cholangiocarcinoma-Case Report-. Neurol Med Chir (Tokyo) 2007; 47:132-5. [PMID: 17384497 DOI: 10.2176/nmc.47.132] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 67-year-old female presented with a rare metastatic skull tumor from cholangiocarcinoma (CCC) manifesting as a progressive painful subcutaneous tumor. Computed tomography and magnetic resonance (MR) imaging revealed an osteolytic tumor attached to the sigmoid sinus and mastoid sinus. Mass reduction of the tumor was performed and radiotherapy applied to the postoperative cavity. The symptoms resolved following the surgical intervention. The skull metastasis from CCC appeared as heterogeneous intensity on MR imaging reflecting the honeycomb structure. Surgery should be considered to relieve symptoms and improve the patient's quality of life, if there is a low risk of morbidity or mortality. The present case indicates another metastatic pathway through the vertebral plexus in the clinical course of CCC.
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Affiliation(s)
- Junichi Miyamoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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20
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Chang L, Chen YL, Kao MC. Intracranial metastasis of hepatocellular carcinoma: review of 45 cases. ACTA ACUST UNITED AC 2004; 62:172-7. [PMID: 15261518 DOI: 10.1016/j.surneu.2003.10.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2002] [Accepted: 08/04/2003] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although extrahepatic metastasis of hepatocellular carcinoma (HCC) is not uncommon, intracranial metastasis is relatively rare. METHODS We reviewed HCC cases admitted in our hospital in the past 16 years, and there were only 45 cases with clinically diagnosed intracranial metastasis. Their age ranged from 14 to 82 years with the peak in the 3rd and 4th decades, which is much younger than the average age of the HCC patients. RESULTS Of the 45 patients, 39 (39/45, 86.7%) had hepatitis B related and 20 (20/45, 44.4%) had cirrhosis of the liver. Intracranial hemorrhage as the initial manifestation was common in our series (18/45, 40%). Hemiparesis was found in 14 cases, scalp mass in 9 cases, headache in 13 cases, diplopia in 3 cases (1 ultimately became totally blind), homonymous hemianopsia in 2 cases, dysarthria in 3 cases, gait disturbance in 1 case, seizure in 3 cases, and aphasia in 1 case. The modes of therapy for patients with intracranial metastasis included conservative medical treatment only or surgical excision and/or radiotherapy. In this series, elevated AFP was noted in 32 patients, and alpha fetoprotein higher than several thousands was even noted in 30 patients; extraordinary high level (>70000) was also seen in more than one-half of the patients. CONCLUSIONS HCC patients with intracranial metastasis presented a very poor prognosis. In general, they deteriorated rapidly and expired without active treatment. Surgical excision of the intracranial metastatic mass, followed by radiotherapy, can improve the life quality and prolong survival time.
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Affiliation(s)
- Lin Chang
- Department of Neurosurgery, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
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21
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Chan CHP, Trost N, McKelvie P, Rophael JA, Murphy MA. Unusual case of skull metastasis from hepatocellular carcinoma. ANZ J Surg 2004; 74:710-3. [PMID: 15315584 DOI: 10.1111/j.1445-1433.2004.02961.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hepatocellular carcinoma with a skull metastasis is a rare clinical entity especially in Western countries. The authors of the present article report a case of solitary skull metastasis from hepatocellular carcinoma in a 75-year-old lady who had no prior history of the primary disease or liver dysfunction. The clinicopathological and radiological features are reviewed and discussed.
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Affiliation(s)
- Chow Huat Patrick Chan
- Department of Neurosurgery, St Vincent's Hospital, Melbourne, Victoria Parade, Fitzroy, Victoria 3065, Australia
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McIver JI, Scheithauer BW, Rydberg CH, Atkinson JL. Metastatic hepatocellular carcinoma presenting as epidural hematoma: case report. Neurosurgery 2001; 49:447-9. [PMID: 11504122 DOI: 10.1097/00006123-200108000-00034] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE A case of acutely symptomatic epidural hematoma caused by metastatic hepatocellular carcinoma (HCC) to the cranium is reported. This is a rare case of metastatic HCC without known primary presenting as an epidural hematoma. CLINICAL PRESENTATION The patient presented with an acute onset of headache, aphasia, and right hemiparesis 2 weeks after he experienced minor trauma to the cranium. An emergency computed tomographic scan of the head revealed the presence of a left parietal epidural hematoma. INTERVENTION An emergency evacuation of the epidural hematoma was performed, and metastatic HCC was diagnosed. CONCLUSION The patient's neurological deficits were reversed with surgical intervention, and he is now undergoing palliative chemotherapy. This was the first clinical manifestation of HCC in this patient. This case reaffirms the neurosurgeon's role in the complex, multidisciplinary care of patients with craniospinal metastasis.
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Affiliation(s)
- J I McIver
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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23
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McIver JI, Scheithauer BW, Rydberg CH, Atkinson JL. Metastatic Hepatocellular Carcinoma Presenting as Epidural Hematoma: Case Report. Neurosurgery 2001. [DOI: 10.1227/00006123-200108000-00034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Hayashi K, Matsuo T, Kurihara M, Daikoku M, Kitange G, Shibata S. Skull metastasis of hepatocellular carcinoma associated with acute epidural hematoma: a case report. SURGICAL NEUROLOGY 2000; 53:379-82. [PMID: 10825524 DOI: 10.1016/s0090-3019(00)00208-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although epidural hematoma is well documented in trauma patients, its association with other etiologies, such as neoplasms, is not widely known. Here the authors report a case of acute epidural hematoma that originated from a metastatic hepatocellular carcinoma (HCC) in the skull. CASE DESCRIPTION A 70-year-old male was admitted to our hospital with left-sided hemiparesis. Preoperative computed tomography (CT) revealed a lenticular high-density area adjacent to the right parietal bone, consistent with an acute epidural hematoma. A subsequent magnetic resonance image (MRI) showed a skull tumor adjacent to the epidural hematoma. Removal of the tumor and evacuation of the hematoma were performed and the pathological diagnosis was metastatic HCC. Postoperatively, the patient gradually recovered but he died of pneumonia 2 months later. CONCLUSION This report represents an additional example of a rare case of metastatic skull tumor associated with acute epidural hematoma. The authors suggest that metastatic skull tumors may be one of the important differential diagnoses in patients with acute epidural hematoma.
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MESH Headings
- Acute Disease
- Aged
- Carcinoma, Hepatocellular/complications
- Carcinoma, Hepatocellular/pathology
- Cerebral Angiography
- Diagnosis, Differential
- Fatal Outcome
- Hematoma, Epidural, Cranial/complications
- Hematoma, Epidural, Cranial/pathology
- Hematoma, Epidural, Cranial/surgery
- Humans
- Liver Neoplasms/complications
- Liver Neoplasms/pathology
- Magnetic Resonance Imaging
- Male
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/surgery
- Parietal Bone/diagnostic imaging
- Parietal Bone/pathology
- Parietal Bone/surgery
- Parietal Lobe/pathology
- Parietal Lobe/surgery
- Skull Neoplasms/diagnosis
- Skull Neoplasms/secondary
- Skull Neoplasms/surgery
- Tomography, X-Ray Computed
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Affiliation(s)
- K Hayashi
- Department of Neurosurgery, Juzenkai Hospital, Nagasaki, Japan
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25
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Hamamoto O, Nakano H, Guerreiro NE, Bizzacchi JM, Dantas Filho VP, Carelli EF, Facure JJ. [Spontaneous epidural hematoma. Report of two cases]. ARQUIVOS DE NEURO-PSIQUIATRIA 1998; 56:453-6. [PMID: 9754428 DOI: 10.1590/s0004-282x1998000300016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Spontaneous epidural hematomas are rarely described in literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura-mater and metastasis to the skull. The authors report two cases of spontaneous epidural hematoma of different etiologies, and study parameters of hemostasis.
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Affiliation(s)
- O Hamamoto
- Disciplina de Neurocirurgia, Faculdade de Medicina de Marília (FAMEMA), Universidade Estadual de Campinas (FCM/UNICAMP), Brasil
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26
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Aractingi S, Bachmeyer C, Miclea JM, Vérola O, Rousselot P, Dubertret L, Daniel MT. Unusual specific cutaneous lesions in myelodysplastic syndromes. J Am Acad Dermatol 1995; 33:187-91. [PMID: 7622643 DOI: 10.1016/0190-9622(95)90232-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Early diagnosis of leukemia cutis in myelodysplastic syndrome (MDS) is important because these lesions can precede acute peripheral blood or bone marrow transformation. Leukemia cutis is usually easy to recognize, but atypical lesions are not well described. OBJECTIVE Our purpose was to describe unusual specific lesions in MDS. METHODS Data from patients with myeloid malignancies and leukemia cutis were reviewed. Only patients with MDS and cutaneous lesions different from typical tumors were included. Clinical features were analyzed. RESULTS Four patients with MDS and unusual specific cutaneous lesions were found. They had ecchymoses, necrotic plaques or ulcers, and prurigo-like lesions. In three of four patients appearance of these skin lesions heralded or was concomitant with acute transformation. CONCLUSION Specific cutaneous lesions can display unusual patterns. Early biopsy of cutaneous lesions in MDS is indicated.
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Affiliation(s)
- S Aractingi
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
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