Solitary skull metastasis as initial presentation of hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the most common primary tumor of liver. HCC usually metastasizes to regional lymph nodes and lungs, less commonly to bone and rarely to the skull. Herein we present a case of 73 year old gentleman who presented with an occipital swelling. CT head detected mass suggestive of hemangiopericytoma with a differential of metastasis and MRI showed heterogenous signal intensity mass probably metastasis. Cytological diagnosis revealed cranial metastasis. Subsequent CECT abdomen reported a 12x11x11cm heteregenous enhancing mass suggestive of hepatocellular carcinoma. Patient was planned for craniectomy and transarterial chemoembolization to treat primary cancer but he refused further treatment inspite of extensive counseling. Primary presentation with skeletal metastases is rare in HCC and only few cases have been reported so far but it should be considered in the differential diagnosis in patients with subcutaneous scalp mass.