S3163 Skull Metastasis in a Patient With HCC

Abstract

Introduction: Hepatocellular carcinoma (HCC) rarely metastasizes to the skull. The prevalence of skull metastasis in HCC has been described to be 6.1%. Cranial nerve deficits are seen in more than a third of patients presenting with skull metastasis. We present a patient with a diagnosis of HCC with a concomitant soft tissue mass at the clivus concerning metastatic HCC. Case Description/Methods: A 62-year-old male with a medical history of cirrhosis secondary to hepatitis C, arterial hypertension and type 2 diabetes mellitus who arrived to our institution due to 5-day history of progressive abdominal swelling and distension. In addition, he referred to having intense left-sided headache and visual disturbances, described as "double vision," three months before arrival. The physical exam showed an uncomfortable, acutely ill, with a temporal wasting patient. HEENT exam revealed the inability to abduct his left eye—suggestive of cranial nerve VI palsy—and tongue deviation to the right side. Also, the abdominal exam showed a soft and depressible abdomen, with flank dullness and mild abdominal tenderness to palpation. Imaging workup included a brain MRI which showed a soft tissue mass at the clivus extending superiorly to the suprasellar region invading the sphenoid sinuses. Additional abdominopelvic CT scan revealed a cirrhotic liver with associated portal hypertension, a large infiltrative right liver lobe LT-TIV observation due to hepatocellular carcinoma (HCC), and celiac lymph node findings concerning for metastatic disease. Management strategies include performing a diagnostic and therapeutic paracentesis which yielded results concerning portal hypertension. Neurosurgery service evaluated the patient and recommended radiotherapy without further neurosurgery management. The patient was eventually discharged home with multidisciplinary follow-up. Discussion: Skull metastasis from HCC is uncommon; but it is notorious for affecting the patient's prognosis and quality of life. Therefore, it is important to make an early diagnosis and properly manage skull metastasis from HCC. This case exhibits the importance of considering the skull and brain metastases of a hepatocellular when evaluating a patient with HCC with neurological symptoms.