A case of hepatocellular carcinoma with skull metastasis as the first manifestation

LIU Yuan-yuan; ZHOU Zhi-hua; HU Shuai; WANG Hao-sheng; YUAN Jun; ZHOU Jin-xu

doi:10.13798/j.issn.1009-153X.2024.10.016

Abstract：Hepatocellular carcinoma is one of the common solid malignant neoplasms,associated with a high mortality rate.Extrahepatic metastasis typically occurs in the advanced stage of the tumor,featuring a narrow time window and an unfavorable prognosis.Skull metastasis of primary hepatocellular carcinoma represents a rare metastatic lesion,and the manifestation of an isolated skull mass as the initial symptom is even more infrequent.This paper presents a case of a 65-year-old female patient who sought medical attention due to the progressive enlargement of a mass on the right parietal region.Cranial CT and MRI examinations disclosed a space-occupying lesion in the right parietal bone,approximately 6.4×5.6 cm in size,accompanied by severe bone destruction.After the completion of preoperative assessment,a resection of the right parietal space-occupying lesion was conducted under general anesthesia.Intraoperatively,it was identified that the tumor was located outside the dura mater and invaded the superior sagittal sinus.The tumor was successfully and completely excised,and the postoperative pathological diagnosis confirmed it as metastatic hepatocellular carcinoma.Postoperative abdominal CT scan revealed a liver space-occupying lesion;however,postoperative liver cancer-related tumor markers(alpha-fetoprotein,carcinoembryonic antigen,carbohydrate antigen 199,and 125)were all within the normal range.The patient was followed up for 4 months postoperatively,and no recurrence of skull metastasis was noted.This case implies that when a head mass undergoes rapid growth within a short period,the possibility of skull metastasis should be contemplated.