Skull metastasis of hepatocellular carcinoma associated with acute epidural hematoma: a case report

Hayashi, Kentarō; Matsuo, Takayuki; Kurihara, Masaki; Daikoku, Manabu; Kitange, Gaspar J.; Shibata, Shôbu

doi:10.1016/s0090-3019(00)00208-1

Cited by 45 publications

(42 citation statements)

References 8 publications

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“…The development of spontaneous AEDH from metastatic HCC of the skull is extremely rare, and only 6 cases have been previously reported in the literature (3)(4)(5)(6)8,9). The present study reports the case of a patient with spontaneous AEDH that developed from a skull metastasis of HCC, and the clinical presentation and pathogenesis are discussed with a review of the literature.…”

Section: Introductionmentioning

confidence: 79%

“…Spontaneous AEDH of skull metastases from HCC is a rare condition, and only 6 cases have been previously reported in the literature (Table I) (3)(4)(5)(6)8,9). Based on the review of the cases, the majority of AEDH patients experience a severe headache followed by neurological deficits, including the deterioration of consciousness or hemiparesis (3,4,6,8,9).…”

Section: Discussionmentioning

confidence: 99%

“…However, several characteristics of HCC may contribute to intracranial bleeding. First, HCC contains numerous sinusoid-like vessels, and the fragility of these vessels may lead to hemorrhage and the formation of the epidural hematoma (3)(4)(5)(6)8,9). Second, coagulopathy caused by hepatic dysfunction may increase the risk of tumor bleeding (3,5,6,9).…”

Section: Discussionmentioning

confidence: 99%

“…First, HCC contains numerous sinusoid-like vessels, and the fragility of these vessels may lead to hemorrhage and the formation of the epidural hematoma (3)(4)(5)(6)8,9). Second, coagulopathy caused by hepatic dysfunction may increase the risk of tumor bleeding (3,5,6,9). Third, the destructive growth of metastatic HCC may lead to the breakdown of the vessel structures in the peritumoral tissue, as demonstrated in osteolytic change (5,6,8).…”

Section: Discussionmentioning

confidence: 99%

“…HCC commonly metastasizes to the lung, regional lymph nodes, peritoneum and adrenal glands (3). Although osseous metastasis, including metastasis to the vertebral body, sternum, ribs and long bones, is not uncommon and demonstrates an incidence between 2 and 16% in HCC, metastasis to the cranium is rare, with an incidence of 0.4-1.6% (4-6).…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous acute epidural hematoma developed due to skull metastasis of hepatocelluar carcinoma: A case report and review of the literature

et al. 2015

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Abstract. Acute epidural hematoma (AEDH) is one of the most common pathological types of head trauma, and may develop without an accidental event, although this is uncommon. The present study reports the case of a 41-year-old male patient that developed spontaneous AEDH due to skull metastasis of hepatocellular carcinoma (HCC). The man was admitted to Chonnam National University Hwasun Hospital and Medical School due to drowsiness and right-sided hemiparesis. A computed tomography scan of the head revealed the presence of a large AEDH and a lytic bone lesion in the left posterior fossa and parieto-occipital region, which exhibited heterogeneous enhancement. The perioperative findings revealed a large amount of mixed-stage epidural hematoma and a soft hemorrhagic mass that exhibited lytic change on the occipital bone. No evidence of head trauma, such as skull fracture or scalp contusion, was detected. The pathological diagnosis was hematoma with metastatic HCC. The current study reports the rare case of a patient with a metastatic tumor located in the skull that resulted in the development of spontaneous AEDH. Once a sudden and unpredicted neurological deficit occurs in a patient with HCC that is also diagnosed with skull metastasis, the possibility of spontaneous AEDH developing from the metastasis should be considered.

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Section: Introductionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spontaneous acute epidural hematoma developed due to skull metastasis of hepatocelluar carcinoma: A case report and review of the literature

et al. 2015

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Metastases from Cancers of the Abdominal Organs

2002

TxNxM1

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Metastatic disease of the brain: extra-axial metastases (skull, dura, leptomeningeal) and tumour spread

2004

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Extra-axial intracranial metastases may arise through several situations. Hematogenous spread to the meninges is the most frequent cause. Direct extension from contiguous extra-cranial neoplasms, secondary invasion of the meninges by calvarium and skull base metastases, and migration along perineural or perivascular structures are less common. Leptomeningeal invasion gives rise to tumour cell dissemination by the cerebrospinal fluid (CSF), eventually leading to neoplastic coating of brain surfaces. Contrast-enhanced magnetic resonance (MR) imaging is complementary to CSF examinations and can be invaluable, detecting up to 50% of false-negative lumbar punctures. MR findings range from diffuse linear leptomeningeal enhancement to multiple enhancing extra-axial nodules, obstructive communicating and non-communicating hydrocephalus. Both calvarial and epidural metastases infrequently transgress the dura, which acts as a barrier against tumour spread. Radionuclide bone studies are still a valuable screening test to detect bone metastases. With computed tomography (CT) and MR, bone metastases extending intracranially and primary dural metastases show the characteristic biconvex shape, usually associated with brain displacement away from the inner table. Although CT is better in detecting skull base erosion, MR is more sensitive and provides more detailed information about dural involvement. Perineural and perivascular spread from head and neck neoplasms require thin-section contrast-enhanced MR.

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Skull metastasis of hepatocellular carcinoma associated with acute epidural hematoma: a case report

Cited by 45 publications

References 8 publications

Spontaneous acute epidural hematoma developed due to skull metastasis of hepatocelluar carcinoma: A case report and review of the literature

Spontaneous acute epidural hematoma developed due to skull metastasis of hepatocelluar carcinoma: A case report and review of the literature

Metastases from Cancers of the Abdominal Organs

Metastatic disease of the brain: extra-axial metastases (skull, dura, leptomeningeal) and tumour spread

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