Wael Sherif, Hamdy Omar, Yasser Mohamed, Elmandrawi Sara, Mostafa Mai, Mohammed Nouran, Elghrieb Ahmed
Mansoura University Hospitals, Mansoura, Egypt.
Surgical Oncology Department, Mansoura University Oncology Center, Mansoura, Egypt.
Patient Saf Surg. 2025 Apr 22;19(1):12. doi: 10.1186/s13037-025-00434-2.
Hepatocellular carcinoma (HCC) ranks among the leading causes of cancer-related deaths worldwide, with metastatic spread to bones being alarmingly frequent. However, HCC metastases to the skull are notably rare, accounting for only 0.4-1.6% of all bone metastases. Typically, metastases are found in the spine, pelvis, and ribs. The occurrence of solitary skull metastases, especially in the absence of active primary liver cancer, is extremely uncommon.
We present the clinical case of a 57-year-old male patient with a documented history of hepatitis C virus infection but without prior evidence of active hepatocellular carcinoma. Over the course of several months, he developed a non-tender, progressively enlarging mass located in the occipital region of the skull. A computed tomography (CT) scan identified a lytic lesion with intracranial compression, although no midline shift was noted. Histopathological examination confirmed the lesion as metastatic HCC, further supported by immunohistochemical markers Hepatari- 1 and Cytokeratin- 19. Subsequent diagnostic procedures revealed hepatic lesions, including a positron emission tomography (PET)-CT scan. Further examination through CT imaging of the abdomen with contrast highlighted a well-defined focal lesion in hepatic segment 4a, measuring 4.3 × 4.3 cm, predominantly enhancing with HCC characteristics. The skull lesion was surgically removed en bloc, and the patient underwent adjunct radiotherapy and systemic therapy, with palliative therapy till his death in May 2024. To better understand and manage this atypical presentation, we conducted a review for the discussion of clinical manifestations, imaging findings, pathological features, and patient outcomes associated with HCC skull metastases.
This case emphasizes the critical importance of considering hepatocellular carcinoma in the differential diagnosis of solitary skull lesions, especially in patients with risk factors for liver disease. Prompt identification of the primary malignancy remains essential for ensuring optimal management and improving patient prognosis.
肝细胞癌（HCC）是全球癌症相关死亡的主要原因之一，骨转移极为常见。然而，HCC转移至颅骨极为罕见，仅占所有骨转移的0.4 - 1.6%。通常，转移灶见于脊柱、骨盆和肋骨。孤立性颅骨转移的发生，尤其是在无活动性原发性肝癌的情况下，极为罕见。
我们报告一例57岁男性患者的临床病例，该患者有丙型肝炎病毒感染病史，但既往无活动性肝细胞癌证据。在数月时间里，他在颅骨枕部出现一个无压痛、逐渐增大的肿块。计算机断层扫描（CT）显示一个溶骨性病变伴颅内压迫，虽未观察到中线移位。组织病理学检查确诊该病变为转移性HCC，免疫组化标记物Hepatari - 1和细胞角蛋白 - 19进一步支持了这一诊断。随后的诊断程序发现了肝脏病变，包括正电子发射断层扫描（PET） - CT扫描。通过腹部增强CT成像进一步检查发现肝4a段有一个边界清晰的局灶性病变，大小为4.3×4.3 cm，主要呈HCC特征性强化。颅骨病变被整块手术切除，患者接受了辅助放疗和全身治疗，并接受姑息治疗直至2024年5月去世。为更好地理解和处理这种非典型表现，我们进行了一项综述，以讨论与HCC颅骨转移相关的临床表现、影像学表现、病理特征和患者预后。
该病例强调了在孤立性颅骨病变的鉴别诊断中考虑肝细胞癌的至关重要性，尤其是在有肝病危险因素的患者中。及时识别原发性恶性肿瘤对于确保最佳治疗和改善患者预后仍然至关重要。
