A case of monocular blindness as the initial presentation of hepatocellular carcinoma with skull metastasis

Abstract

A 52-year-old man suffering from monocular blindness, with light perception only, was admitted to our hospital. The symptom had begun as low vision and developed rapidly within 3 weeks into monocular blindness in the right eye, with no other systemic manifestations. Imaging examinations revealed multiple hepatocellular carcinomas in the cirrhotic liver, and tumors at the skull base and vertebra. A pathological and immunochemical study of specimens obtained by endoscopic transnasal tumor biopsy and laminectomy revealed them to be metastatic hepatocellular carcinomas (HCCs). Although the patient underwent radiation therapy and chemotherapy, he died 5 months after admission to our hospital. The cranial HCC, involving only the optic canal, may have disturbed the optic nerve in preference to the other cranial nerves. This is the first report of a HCC patient with monocular blindness as the initial presentation of the disease.

Hepatocellular Carcinoma Metastasis Presenting as Isolated Third Nerve Palsy

“…2 Very rarely, skull base metastasis can cause ocular symptoms, although typically late in the disease course or in the setting of other extensive liver damage. [3][4][5][6][7] Visual symptoms as the presenting manifestation of HCC are extremely rare. 2 To the best of our knowledge, this is the first report of metastatic HCC manifesting as an isolated cranial nerve palsy, without any previously known liver disease.…”

“…2 Only a small number of cases have reported ocular symptoms caused by skull base metastases, all of them occurring in the setting of long-standing HCC, hepatitis infection, excessive alcohol consumption, or other history of extensive liver damage. [3][4][5][6][7] To our knowledge, no prior cases of metastatic HCC have presented with an isolated third cranial nerve palsy. Although rare, this case highlights how compressive lesions can cause a third cranial nerve palsy without pupillary involvement, reinforcing the need for urgent imaging of all third cranial nerve palsies.…”

“…Orbital metastasis is the most frequent cause of ocular symptoms associated with HCC, 2 with only a small number of cases reporting ocular symptoms due to skull base metastasis. [3][4][5][6][7] Proptosis, with or without pain, is the most common ocular symptom associated with HCC although diplopia, decreased vision, ophthalmoplegia, and ptosis have also been reported. 2 Metastasis is typically associated with advanced stages of previously diagnosed HCC or other extensive liver damage, but may rarely be the presenting symptom that leads to a diagnosis of HCC.…”