title: Brain metastasis of hepatocellular carcinoma detected after liver transplantation.
abstract: OBJECTIVE
  We report the case of a patient with hepatocellular carcinoma submitted to liver transplantation, who subsequently manifested tumor recurrence initially as brain metastasis.
  
  
  METHODS
  A 48-year-old male cirrhotic patient with hepatitis C infection, and two focal hepatic lesions, had a cytologic and histologic diagnosis of hepatocellular carcinoma. Before transplant, he was submitted to adjuvant treatment with a combination of arterial embolization and intratumoral ethanol injection. In the 3rd month post-liver transplantation, the patient developed headache, nausea and vomiting, without any neurological impairment. Brain computed tomography and magnetic resonance imaging identified an expansive hypervascular lesion with internal bleeding. Evaluation of the surgical explant revealed macroscopic invasion of portal vessels.
  
  
  CONCLUSIONS
  Brain metastasis of a hepatocellular carcinoma after liver transplantation may occur. This metastasis may have occurred before or soon after the transplant. Patients with hepatocellular carcinoma, awaiting liver transplant, should be screened for cerebral metastasis. Vascular invasion may indicate hematogenic dissemination of the tumor.
authors.affiliation: Liver Transplant Group, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, SP, Brazil. avcfranca@hcrp.fmrp.usp.br
authors.forename: Alex Vianey Callado
authors.initials: AV
authors.lastname: França
authors.forename: Ana
authors.initials: A
authors.lastname: Martinelli
authors.forename: Orlando Castro E
authors.initials: OC
authors.lastname: Silva
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged