Chen Jeffrey Wu, Giridharan Nisha, Kavoussi Arman A, Van Arsdale Dawn, Hosseingholi Nouri Shervin, Nitturi Vijay, Trudeau Trevor, Mandel Jacob J, Lu Hsiang-Chih, Patel Akash J
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States.
Department of Neurology, Baylor College of Medicine, Houston, Texas, United States.
Surg Neurol Int. 2025 Jan 10;16:6. doi: 10.25259/SNI_507_2024. eCollection 2025.
Hepatocellular carcinoma (HCC) contributes significantly to global cancer-related mortality, often because patients present at advanced stages of the disease. HCC commonly metastasizes to the lung, abdominal lymph nodes, and bone. However, even among bony metastases, calvarial lesions are exceptionally rare, especially in the initial presentation.
We describe a unique case of a 65-year-old African American woman who presented with a rapidly growing skull lesion as her first clinical sign of metastatic HCC. Imaging revealed an extensive soft-tissue mass involving the left calvaria and partially obstructing the superior sagittal sinus. We suspected that the lesion was a meningioma and offered surgery. Histological examination and further systemic workup later confirmed HCC. She was started on adjuvant therapy but unfortunately deteriorated from complications secondary to disease progression. We also reviewed the literature on cases of isolated calvarial metastases as the initial presentation of HCC. A total of 36 case reports were reviewed which included 38 patients. There were 32 males (84.2%), and the mean age was 58.97 ± 9.09 years old. The most common location of presentation was the parietal or occipital region (13, 34.2%), and 18 patients (47.4%) underwent neurosurgical treatment of the lesion. Among the 26 cases that had a follow-up, 84.6% ( = 22) did not survive treatment, and the mean survival time was 6.15 ± 5.94 months.
Isolated calvarial lesions are rarely the initial presenting sign of metastatic HCC. Often, these lesions may be misdiagnosed as benign tumors, such as meningiomas or hemangiopericytomas, given their appearance on imaging. However, early identification of HCC skull lesions is crucial to initiating treatment, including resection, radiation, and immunotherapy, which may help improve symptoms and extend survival. Our case report adds to the limited literature on this exceedingly rare entity.
肝细胞癌（HCC）是全球癌症相关死亡的重要原因，通常是因为患者在疾病晚期才出现症状。HCC常见转移至肺、腹部淋巴结和骨骼。然而，即使在骨转移中，颅骨病变也极为罕见，尤其是在疾病初发时。
我们报告了一例独特的病例，一名65岁非裔美国女性，以快速生长的颅骨病变作为转移性HCC的首个临床症状。影像学检查显示广泛的软组织肿块累及左颅骨，并部分阻塞上矢状窦。我们怀疑该病变为脑膜瘤并建议手术。组织学检查及进一步的全身检查后来确诊为HCC。她开始接受辅助治疗，但不幸的是因疾病进展引发的并发症而病情恶化。我们还回顾了以孤立性颅骨转移作为HCC初发表征的病例相关文献。共查阅了36篇病例报告，涉及38例患者。其中男性32例（84.2%），平均年龄为58.97±9.09岁。最常见的发病部位是顶叶或枕叶区域（13例，34.2%），18例患者（47.4%）接受了该病变的神经外科治疗。在有随访记录的26例病例中，84.6%（22例）治疗后未存活，平均生存时间为6.15±5.94个月。
孤立性颅骨病变很少是转移性HCC的初发表征。鉴于其影像学表现，这些病变常可能被误诊为良性肿瘤，如脑膜瘤或血管外皮细胞瘤。然而，早期识别HCC颅骨病变对于启动包括手术切除、放疗和免疫治疗在内的治疗至关重要，这可能有助于改善症状并延长生存期。我们的病例报告补充了关于这一极其罕见疾病的有限文献。
