Brain metastasis of hepatocellular carcinoma: A case report and review of the literature.

Abstract

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies in the world. It is more common in far eastern countries and relatively rare in the United States and western European countries where at autopsy it accounts for only 1%-2% of malignant tumors. The disease is usually manifested in the the 6th and 7th decade of life. HCC is one of the highly malignant neoplasms. Extrahepatic metastases are seen in 64% of patients with HCC. The lungs, regional lymph nodes, kidney, bone marrow and adrenals are common sites of HCC metastasis[1-3]. But, metastasis to brain and skull is extremely rare. Table ​Table11 shows some of the reported cases of HCC with brain metastasis. These case reports reaffirms the complex and multidisciplinary care of these patients[4-15]. Table 1 Some of the previous case presentations with HCC and brain metastasis in the literature The interval between diagnosis of primary cancer and detection of brain metastasis ranged from 2 to 54 mo. The mean survival period was only 3 mo after diagnosis of brain metastasis. The patients with HCC metastasized to brain died of neurologic causes rather than hepatic failure. Although no treatment is clearly defined to increase survival in patients with unresectable tumors, early diagnosis could improve the chance of curative surgical resection[9-12]. We describe a case of HCC presenting with the initial manifestations of an intracranial mass lesion without any symptoms or signs suggestive of the primary hepatic site of the tumor. The diagnosis could not be made until he was admitted to hospital with unilateral weakness and numbness.