title: Hepatocellular carcinoma metastasizing to the skull base involving multiple cranial nerves.
abstract: We describe a rare case of HCV-related recurrent multiple hepatocellular carcinoma (HCC) metastasizing to the skull base involving multiple cranial nerves in a 50-year-old woman. The patient presented with symptoms of ptosis, fixation of the right eyeball, and left abducens palsy, indicating disturbances of the right oculomotor and trochlear nerves and bilateral abducens nerves. Brain contrast-enhanced computed tomography (CT) revealed an ill-defined mass with abnormal enhancement around the sella turcica. Brain magnetic resonance imaging (MRI) disclosed that the mass involved the clivus, cavernous sinus, and petrous apex. On contrast-enhanced MRI with gadolinium-chelated contrast medium, the mass showed inhomogeneous intermediate enhancement. The diagnosis of metastatic HCC to the skull base was made on the basis of neurological findings and imaging studies including CT and MRI, without histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.
authors.affiliation: Department of Gastroenterology, Kobe Asahi Hospital, and Department of Neurology, Kobe University Hospital, 653-0801, Japan. info@kobe-asahi-hp.com
authors.forename: Soo Ryang
authors.initials: SR
authors.lastname: Kim
authors.forename: Fumio
authors.initials: F
authors.lastname: Kanda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kobessho
authors.forename: Koji
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Hayashi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000556:secondary*; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis / Q000556:secondary*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000473:pathology; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000556:secondary*; D014057:Tomography, X-Ray Computed