Single Cavernous Sinus Metastasis as the First Manifestation of Hepatocellular Carcinoma—A Rare Case Report and Review of Literature

Abstract

Introduction: The metastasis of hepatocellular carcinoma is rare in skull base and even more rare to cavernous sinus.Case Report: We report an extremely rare case of solitary cavernous sinus metastasis without metastasis to any other site, with left 6 nerve palsy as the initial manifestation of the disease.Discussion: The biopsy specimen of cavernous sinus suggested metastatic hepatocellular carcinoma. Subsequent examination revealed a large mass involving posterior segment of right lobe of liver, which was confirmed as hepatocellular carcinoma on histopathological examination. Conclusion:There have been only 25 cases of hepatocellular carcinoma metastasizing to skull base cited in literature of today, from which only 5 cases were in cavernous sinus. In this report, we introduce an unusual case of solitary cavernous sinus metastasis from hepatocellular carcinoma before the diagnosis of primary tumor.

A Trigeminal Neuropathy From an Inactive Hepatocellular Carcinoma

“…Metastasis to the skull base is reported to be 0.4%-1.6%. Solitary metastasis to the skull base without symptomatic evidence of primary in the liver or other sites is an extremely rare and uncommon presentation of HCC [5].…”