[Simple metastasis of hepatocellular carcinoma to the skull--a case report]

The patient, a 53-year-old man, was admitted to the Department of Neurosurgery, Nagasaki University Hospital in August 1979, because of a painful tumor in the lt-parieto-occipital region. Physical examination on admission revealed a fist-sized tumor in the lt-parieto-occipital region. The liver edge was palpable at two finger breadths beneath the right costal margin, but the liver itself was not palpable as a mass. Liver function was almost good except for GOT and ChE. Plain craniography showed an osteolytic change of about 10 cm X 10 cm in size without marginal hyperostosis and spicular formation. Bilateral external carotid angiography demonstrated a hypervascular mass, which was fed by the bilateral superficial temporal arteries and occipital arteries. CT scan also demonstrated a fist-sized tumor originating from the diploë with destruction of the skull bone. Tumor was strongly enhanced. A radical removal of tumor was performed. Tumor was solid with profuse bleeding and adhered tightly to the dura and the skin. The postoperative course was uneventful and postoperative CT scan demonstrated complete removal of the tumor. Histological diagnosis was hepatocellular carcinoma and the skull tumor was considered to be metastatic. CT scan of the liver showed a circumscribed low density area with ring enhancement at the posterior ventral site. As no metastasis was found in other organ except the skull, so primary lesion was radically removed at the Second Department of Surgery. The incidence of metastasis to the bone in hepatocellular carcinoma in autopsy studies has been considered rarely approximately from 4 to 14%. Moreover, the common sites of skeletal metastasis are the vertebral column, the ribs, the long bones and so on. Metastases to the skull bone was exceptionally rare and all cases hitherto reported had multiple metastases in other organ(s) and no literature was found about the distant metastasis to the skull bone only.