Del Ben M, Caporale A, Feole K, Alessandri C, Angelico F
Dept. of Experimental Medicine and Pathology, University of Rome La Sapienza, Rome, Italy.
J Exp Clin Cancer Res. 2003 Dec;22(4):641-4.
Brain metastases from hepatocarcinoma are exceptional and only a few cases have been reported in the literature, mainly from Far-Eastern countries. Clinical diagnosis in asymptomatic patients with preserved liver function is difficult and usually late. In some cases, cerebral metastasis is the initial manifestation of HCC and patients may develop intracerebral hemorrage and have a stroke-like presentation. We report on the first Italian case of cerebral metastases from multifocal hepatocellular carcinoma in an asymptomatic HbsAg negative patient with unknown HCV related chronic hepatitis and no evidence of liver cirrhosis. For many years he had a mild liver enzyme elevation and the presence of multiple misinterpreted hypoechogenic hepatic lesions. The hepatic tumor spread to the lungs and the brain and the patient developed two major episodes of intracranial hemorrage. He had two nodular lesions in the brain and alpha-fetoprotein levels were more than 10,000 ng/ml. He died from neurologic causes, without major signs of liver failure.
肝癌脑转移极为罕见，文献中仅报道过少数病例，主要来自远东国家。对于肝功能正常的无症状患者，临床诊断困难且通常较晚。在某些情况下，脑转移是肝癌的首发表现，患者可能会发生脑内出血，呈现类似中风的症状。我们报告了意大利首例多灶性肝细胞癌脑转移病例，患者无症状，乙肝表面抗原阴性，丙肝相关慢性肝炎情况不明，且无肝硬化证据。多年来，他的肝酶轻度升高，存在多个被误诊的低回声肝病灶。肝脏肿瘤扩散至肺部和脑部，患者发生了两次严重的颅内出血。他脑部有两个结节性病变，甲胎蛋白水平超过10,000 ng/ml。他死于神经原因，无严重肝功能衰竭迹象。
