A Case of the Metastatic Hepatocellular Hepatoma to the Skull.

Lim, Yong Soo; Shin, Kwang Chul; Kim, Yong Goo; Cho, Jong Hyo; Moon, Myong Sun

Original Article

Journal of Korean Neurosurgical Society 1975;4(1): 111-116.

Yong Soo Lim, Kwang Chul Shin, Yong Goo Kim, Jong Hyo Cho, Myong Sun Moon

Department of Neurosurgery, Seoul Red Cross Hospital, Seoul, Korea.

ABSTRACT

The majority of metastatic lesions involving the skull arise from carcinoma of the breast and lung. Bone metastass from a wide speculum of malignant neoplasms may be discussed in general as osteoblastic or osteoclastic in type. In osteoblastic from there are carcinoma of the prostate, carcinoma of the breast, carcinoma of the urinary bladder and rarely hypernephroma and cholangiocellular hepatoma. Osteoclastic metastass are characteristically produced by carcinoma of the lung, uterus, gastrointestinal tract, and thyroid and malignant melanoma, and rarely hepatocellular hepatoma, Osteoclastic or osteolytic lesions are much more frequent. Osteolytic metastass to the skull typically present as multiple radiolucenices with ill-defined margin. Metastases may affect any portion of the skull, not only the calvaria but also the base. Recently we experienced a rare case of metastatic hepatocellular carcinoma to the skull. A 51 year old Korean male was admitted to the Dept. of neurosurgery, on Jan. 18, 1975. Patient had complained of headache and mass on the right frontoparietal region for ca 6 weeks and motor weakness on the left extremities for 2 weeks prior to admission. No jaundice and weight loss were complained. The mass on the right frontoparietal region had increased its size gradually and showed adult fist in its size on admission. Neurological examination on admission disclosed that the adult-fist sized mass on the right frontoparietal region was non-tender and palpated soft, and deep tendon reflexes were hyperactive, on the left, and Lt. Superficial reflexes were diminished. No spasticity was noted, and left grasping power was markedly weak. Hypersthesia was felt on the left of the body. No icterus was found. Nor palpable liver neither spleen was found. No tenderness on the abdomen and no palpable masses were noted. Complete blood cell counting was normal. The blood chemistry including the liver function test revealed normal except increased alkaline phosphatase(10.5 Bodansky units). (-feto-protein was negative. Urinalysis and stool examination were normal. X-ray films of simple skull series revealed multiple radiolucencies with ill-defined margins on the right fronto-parietal bone. Right carotid angiograms showed the left square shifting of the right anterior cerebral artery to the left and compressed downward the Rt. Middle cerebral artery, and abnormal vessels in tumor mass were supplied by only the Rt. External carotid artery extracranially and intracranially. Liver scanning was normal. A decompression craniectomy was performed. Extracranially the tumor mass was brownish yellow and soft, which seemed to be the lipoma in character. The skull bone was destroyed multiply. Intracranilly same mass was found. They were removed totally without any bleeding. The operation was finished in usual way, and biopsy was attempted. The post-operative course was usual one except no recovery of the neurologic deficit for 2 weeks. Microscopic examination revealed a metastatic hepatocelluar hepatoma.