Solitary skull metastasis as initial manifestation of hepatocellular carcinoma.
BACKGROUND
A solitary skull metastasis from hepatocellular carcinoma (HCC) prior to diagnosis of the primary tumor without liver dysfunction is a very rare event.


METHODS
A 71-year-old male, without known liver disease, presented to our institution with a palpable occipital scalp mass. On brain magnetic resonance imaging (MRI), a highly enhanced and osteolytic skull tumor was observed. The histological diagnosis obtained from the percutaneous needle biopsy was a cranial metastasis from HCC. The metastatic tumor was removed via occipital craniectomy, and the two primary liver mass lesions were subsequently treated by transarterial chemoembolization.


CONCLUSIONS
An isolated skull metastasis may be the sole initial presentation of HCC. Early diagnosis is essential in order to treat the primary disease. A skull metastasis from HCC should be considered in the differential diagnosis in patients with subcutaneous scalp mass and osteolytic defects on X-ray.
Department of Neurosurgery, Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea. shim60@yumc.yonsei.ac.kr
Yu Shik
YS
Shim
Jung Yong
JY
Ahn
Jun Hyung
JH
Cho
Kyu Sung
KS
Lee
D000368:Aged; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D012886:Skull / Q000473:pathology*; D012888:Skull Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery; D016896:Treatment Outcome