Yen F S, Wu J C, Lai C R, Sheng W Y, Kuo B I, Chen T Z, Tsay S H, Lee S D
Department of Medicine and Pathology, National Yang-Ming Medical College, Taiwan, Republic of China.
J Gastroenterol Hepatol. 1995 Jul-Aug;10(4):413-8. doi: 10.1111/j.1440-1746.1995.tb01593.x.
Hepatocellular carcinoma (HCC) with extrahepatic spreading is not uncommon. In order to delineate the clinical and radiological pictures of HCC with intracranial metastasis, 33 documented cases were analysed. Eighteen had brain parenchymal metastasis without skull involvement; the other 15 cases disclosed skull metastasis with brain invasion. The underlying HCC are mainly of expanding (13/33, 39.4%) and multifocal (13/33, 39.4%) types. Eighteen cases (18/33, 54.5%) had mental changes not related to hypoglycaemia or hepatic encephalopathy. Eighteen cases (18/20, 90%) disclosed hyperdense mass lesions by non-contrast computed tomography (CT) scans and 17 cases showed homogeneous enhancement (17/22, 77.3%) by post-contrast CT images. In the non-skull involved group, five cases (5/12, 41.7%) disclosed ring-shape enhancement and 14 cases (14/16, 87.5%) had perifocal oedema, which were not seen in the skull involved group. Eight cases (8/33, 24.2%) presented as intracerebral haemorrhage. Twelve (12/33, 36.4%) died of brain herniation. Most (14/18, 77.8%) non-skull involved cases had simultaneous lung metastasis without bony metastasis, while the skull involved group often (10/15, 66.7%) disclosed extracranial bony metastasis without lung metastasis. The difference in extracranial metastasis was statistically significant (P < 0.05). The multivariate survival analysis disclosed that lower lactate dehydrogenase level (< or = 316 U/L, P = 0.029) and treatments (surgery or radiation, P = 0.001) were positively associated with longer survival. In conclusion, HCC with intracranial metastasis is symptomatic and life-threatening. Half the cases may come from pulmonary metastasis and the other half may be from bony metastasis. Brain irradiation or surgery can prolong their survival.
肝细胞癌（HCC）伴肝外转移并不少见。为了描绘HCC颅内转移的临床和影像学表现，对33例有记录的病例进行了分析。18例有脑实质转移而无颅骨受累；另外15例显示有颅骨转移并侵犯脑实质。潜在的HCC主要为膨胀型（13/33，39.4%）和多灶型（13/33，39.4%）。18例（18/33，54.5%）有与低血糖或肝性脑病无关的精神改变。18例（18/20，90%）在非增强计算机断层扫描（CT）中显示高密度肿块病变，17例（17/22，77.3%）在增强CT图像上显示均匀强化。在无颅骨受累组中，5例（5/12，41.7%）显示环形强化，14例（14/16，87.5%）有灶周水肿，而在有颅骨受累组中未见到这些表现。8例（8/33，24.2%）表现为脑内出血。12例（12/33，36.4%）死于脑疝。大多数无颅骨受累病例（14/18，77.8%）同时有肺转移而无骨转移，而有颅骨受累组常（10/15，66.7%）显示颅外骨转移而无肺转移。颅外转移的差异具有统计学意义（P<0.05）。多因素生存分析显示，较低的乳酸脱氢酶水平（≤316 U/L，P = 0.029）和治疗（手术或放疗，P = 0.001）与较长生存期呈正相关。总之，HCC颅内转移有症状且危及生命。一半病例可能来自肺转移，另一半可能来自骨转移。脑部放疗或手术可延长其生存期。
