Introduction Meningiomas are the most commonly encountered intracranial tumors, usually showing indolent behavior. Extra-axial spreading and distant metastases are seldom detected in these tumors, and lung metastasis from a low-grade meningioma is a rare event. Case presentation This case report aimed to present the clinical, imaging, and pathological features of a 37-year-old Caucasian pregnant woman with bilateral lung metastases incidentally detected during preoperative workup ahead of surgery for a primary intracranial meningioma. The possible metastatic routes and risk factors of dissemination to the pulmonary circulation were discussed as well. Conclusion Metastasis must be considered in patients with intracranial meningiomas accompanied by venous sinus invasion and extension through the calvarium. Thorough paraclinical investigations are suggested in such cases.
A solitary skull metastasis from hepatocellular carcinoma is rare. A 38-year-old man with hepatocellular carcinoma presented to our institution with a palpable temporal scalp mass. We took a magnetic resonance image, and discovered an enhanced and osteolytic skull tumor. The tumor was removed by an occipital craniectomy, and the histologic diagnosis was a cranial metastasis owing to hepatocellular carcinoma.A skull metastasis owing to hepatocellular carcinoma should be considered in the differential diagnosis in patients with a subcutaneous scalp mass. Although a distant metastasis can affect the prognosis of the patient, early treatment may improve survival. Key words: Hepatoma, Scalp, Transplant IntroductionHepatocellular carcinoma (HCC) constitutes approximately 3% of all cancers and is considered one of the most common causes of death from cancer. The incidence varies widely in different areas of the world. Many cases occur in countries where there are high rates of chronic hepatitis B virus (HBV) infection. The highest incidences are found in Asian (China, Taiwan) and African countries. Many of these people are exposed to dietary aflatoxins, derived from the fungus Aspergillus flavus, that when combined with HBV infection, increase the risk of HCC. 1,2 In Western countries, the incidence is increasing, but at a much lower rate than it is in Asian countries. The major causative factors are infections with HBV or hepatitis C virus (HCV), chronic alcoholism, and exposure to aflatoxin. Hemochromatosis and hereditary tyrosinemia less commonly give rise to HCC; the tumor usually develops in persons with cirrhosis. 1,2 In Western countries, the tremendous rise in obesity, the metabolic syndrome, and diabetes also are thought to affect the incidence of HCC. Fatty liver and nonalcoholic steatohepatitis may lead to cirrhosis, and eventually, to HCC. 3 Owing to the current vaccination strategies for HBV infection, screening, and treatment for HCV infections, future incidences and the common causes of HCC may change. 2,3 Hepatocellular carcinoma usually metastasizes to regional lymph nodes and the lungs. The incidence of bone metastases is low. 3,4 Multiple extrahepatic metastases usually develop after resection of the primary liver mass that receives palliative chemotherapy. Only a solitary metastasis, such as our case, should be considered for surgical resection. We report a 38-year-old man with a solitary skull metastasis owing to HCC, who presented to us with a painless scalp mass. Case ReportAt the time of this writing, a 38-year-old man presented at our institution with a scalp mass of 1 month's duration. He had no recent history of a head trauma. On local physical examination, there was a well-defined localized mass over right temporal side of his scalp. We detected no head or neck lymphadenopathy. CASe RePORT Case Report of Skull Metastasis From HepatocellularCarcinoma After a Liver Transplant
HighlightsAlthough extremely rare, Eosinophilic granuoma can present at cerebellopontine angle.A trial of steroid can be attempted if intracranial EG is considered a possible diagnosis.Hypo-intensity on T2, which has not been described before, may be correlated with steroid unresponsiveness.Low dose radiotherapy with or without chemotherapy should be considered for non-responders.
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