Hemorrhagic cerebral metastasis as a first manifestation of a hepatocellular carcinoma: case report

Abstract

-We report herein a rare instance in which a patient presented with a hemorrhagic cerebral metastasis as the initial manifestation of a hepatocellular carcinoma (HCC). A few cases of cerebral metastasis from HCC have been reported in the literature, mainly from eastern countries. This is the first report from South America of a cerebral metastasis from hepatocellular carcinoma.KEY WORDS: hepatocellular carcinoma, metastases, brain, hemorrhage. Metástase cerebral hemorrágica como manifestação inicial de um carcinoma hepatocelular: relato de casoRESUMO -Relatamos o caso de um paciente que teve como primeira manifestação de um carcinoma hepatocelular uma metástase cerebral hemorrágica, evento raro na literatura. Os poucos casos de metástase cerebral por carcinoma hepatocelular foram relatados em países do Oriente, onde o tumor é mais comum. Este é o primeiro relato de metástase cerebral de carcinoma hepatocelular da América do Sul. PALAVRAS-CHAVE: carcinoma hepatocelular, metástase cerebral, hemorragia.

Little Response of Cerebral Metastasis from Hepatocellular Carcinoma to Any Treatments

“…One of the noticeable features is that brain metastasis from HCC had a tendency of bleeding as in the previous reports 1,2,4,9,10,13,14,16,18,21) , though no patients were classified as Child-Pugh grade C, and had a delayed prothrombin time in this study. Thus, 70.0% of the patients had stroke-like presentation due to tumor bleeding, and over 90% of the lesions had the hemorrhagic components in or near the mass on MR images and/or CT scan.…”

Central nervous system involvement in hepatocellular carcinoma: Clinical characteristics and comparison of intracranial and spinal metastatic groups

“…[27][28][29][30] The neurological symptoms of intracranial metastasis in HCC patients may develop either insidiously, with signs and symptoms of a mass that include headache, weakness of the limbs and altered consciousness, or abruptly, with intracranial hemorrhage. 31,32 Our patients with intracranial metastasis commonly experienced motor weakness and headache. Seizure is an uncommon presentation of HCC with intracranial metastasis, 16,33 and only two of our patients had this presentation.…”

Primary Clear Cell Carcinoma of the Liver with Intracerebral Hemorrhage as First Presentation: Case Report

“…Due to the rapid progression of the disease, HCC metastasis to the central nervous system, particularly the brain, is unlikely to be prominent in the clinical course. However, brain metastases of HCC may be more likely to cometoclinicalandpathologicalattentionthanextrahepatic metastases in other sites since they often produce clinical symptomsthatnecessitateneurosurgicalinterventionandmetastasisremoval [9,10].Todate,thereisnoestablishedtherapeuticstrategyforbrainmetastasisofHCC.Craniotomy,radiotherapy, or both are commonly performed. Chang et al [11] reported that HCC patients with brain metastases, who receivecraniotomy,radiotherapyorboth,survivelongerthan patients who receive supportive care only (more than 4 monthscomparedwithlessthan1month).Ourpatientdied ofsystemicmetastasis2monthsafterneurosurgicalresection, suggesting the prognosis of brain metastatic PCCCL is ex-…”