Skull Metastasis from the Liver: Case Report and Literature Review

• Published in: World neurosurgery Vol. 108; pp. 989.e15 - 989.e18
• Main Authors: Han, Shuo, Zhang, Xiao-hua, Lv, Tao, Han, Dong-hua
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017
• Subjects: Aged; Calvaria; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - secondary; Carcinoma, Hepatocellular - therapy; Cerebral Angiography; Circulating tumor cells; Embolization, Therapeutic; Humans; Liver Cirrhosis - etiology; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - etiology; Liver Neoplasms - pathology; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Metastases; Neoplastic Cells, Circulating; Primary foci; Schistosomiasis japonica - complications; Skull Neoplasms - diagnostic imaging; Skull Neoplasms - secondary; Skull Neoplasms - therapy; Tomography, X-Ray Computed; CT; Calvaria; CTC; HCC; Circulating tumor cells; Primary foci; Metastases
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.08.104

Calvarial metastasis from liver cirrhosis in the absence of a primary focus is exceptionally rare. Few reports of metastases from hepatocellular carcinoma of an unknown primary focus have been published. A 66-year-old man with a history of Schistosoma japonicum infection presented to our hospital with a mass over the left occipital region associated with headache and dizziness. Imaging revealed a 6 × 5-cm lesion supplied principally by the left occipital artery. The metastatic tumor was removed via super-selective embolization and craniotomy. Pathology revealed that circulating tumor cells from the liver had metastasized to the calvaria. Postoperatively, no primary foci was found over 9 months of follow-up. A calvarial mass may be an initial manifestation of hepatocellular carcinoma. Early diagnosis is important. A calvarial metastasis from the liver, although very rare, should be included in the differential diagnosis of a patient with both cirrhosis and skull mass.