title: Skull metastasis from hepatocellular carcinoma with chronic hepatitis B.
abstract: A 56-year-old male visited our hospital for evaluation of an occipital mass. Contrast computed tomography showed hypervascular enhancement with osteolytic change in the skull and a huge enhanced mass in the liver. Magnetic resonance imaging showed bone metastasis in the thoracic vertebrae. Assays for hepatitis B surface antigen and hepatitis B core antibody were positive and his liver condition was Child-Pugh grade A. Our diagnosis was hepatocellular carcinoma (HCC) with skull and vertebrae metastases on chronic hepatitis B. He was treated with radiation therapy for bone metastases and transcatheter arterial chemoembolization for HCC. But he developed acute respiratory failure because of aspiration pneumonia, congestion and oedema with haemorrhage of the lungs and died. Dissection showed HCC with multiple bone metastases. The liver tumor was categorized as well-differentiated HCC, Edmondson classification I, trabecular type and pseudoglandular type. In the liver mild infiltration of lymphocytes was seen in Glisson's capsules which were significantly enlarged with well preserved limiting plates. Piecemeal necrosis was not obvious. No fibrosis was noted. An 8 cm × 7 cm × 3 cm metastatic lesion had formed in the left occipitotemporal part of the cranial bone. The lesion was osteolytic and showed invasion into the dura mater. Neither the subdural cavity nor the brain showed involvement from the metastatic tumor. However, skull metastasis from HCC is very rare and it affects the patient's prognosis and the quality of life. Therefore, it is very important to make an early diagnosis and carry out proper management of skull metastasis from HCC.
authors.affiliation: Takashi Goto, Takahiro Dohmen, Kouichi Miura, Shigetoshi Ohshima, Kazuo Yoneyama, Tomomi Shibuya, Ei Kataoka, Daisuke Segawa, Wataru Sato, Yumiko Anezaki, Hajime Ishii, Daigo Kon, Ikuhiro Yamada, Kentaro Kamada, Hirohide Ohnishi, Department of Gastroenterology, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Goto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Dohmen
authors.forename: Kouichi
authors.initials: K
authors.lastname: Miura
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Ohshima
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yoneyama
authors.forename: Tomomi
authors.initials: T
authors.lastname: Shibuya
authors.forename: Ei
authors.initials: E
authors.lastname: Kataoka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Segawa
authors.forename: Wataru
authors.initials: W
authors.lastname: Sato
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Anezaki
authors.forename: Hajime
authors.initials: H
authors.lastname: Ishii
authors.forename: Daigo
authors.initials: D
authors.lastname: Kon
authors.forename: Ikuhiro
authors.initials: I
authors.lastname: Yamada
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kamada
authors.forename: Hirohide
authors.initials: H
authors.lastname: Ohnishi