Hepatocellular carcinoma metastasis to the brain mimicking primary pituitary tumor around the sella turcica

Abstract

We report on two cases of hepatocellular carcinoma (HCC) with metastasis to the cavernous sinus and sphenoid sinus. Both cases presented with diplopia and retro-orbital headache and both underwent surgery for a primary pituitary gland tumor. After surgery, both cases were diagnosed with metastases from HCC. Case 1 was a 67-year-old male with a history of HCC who was referred to our hospital for pituitary tumor surgery. The tumor appeared to be in the sella turcica and to invade the sphenoid sinus and right cavernous sinus. Transnasal transsphenoidal surgery (TSS) was performed. The tumor was postoperatively diagnosed by histology to be a metastatic pituitary tumor from HCC. Radiotherapy was administered to the metastatic site. Case 2 was a 58-year-old male with a history of TSS for a pituitary tumor 16 years previously. He was referred to our hospital for TSS for a recurrent pituitary adenoma. TSS was performed twice in 3 months. During a preoperative general examination, HCC and chronic hepatitis B were revealed. TSS was performed initially, followed by arterial infusion chemotherapy. After TSS, the pituitary tumor was diagnosed by histology to be a metastasis from HCC. As with Case 1, radiotherapy was administered to the metastasis. Most tumors in the sella turcica are pituitary adenomas, although some cases of metastatic pituitary tumors and skull base metastases have been reported. Distant metastases generally have a poor prognosis; however, surgery to the metastatic site can effectively control symptoms caused by the metastatic tumor.

Rare case of hepatocellular carcinoma metastasising to the pituitary and cavernous sinus causing panhypopituitarism and bilateral ophthalmoplegia

“…This occurred due to invasion of both cavernous sinuses and compression of cranial nerves III, IV and VI bilaterally, the extent of which has not been previously reported. 9–12 16 Moreover, the tumour had also invaded the clivus and sphenoid sinus. Similar clivus involvement has been reported before with HCC but not together with ophthalmoplegia and panhypopituitarism.…”

Population-Based analysis for newly diagnosed hepatocellular carcinoma with brain metastases

“…24 Second, since data on treatment of cases with brain metastases unavailable in the SEER database no further analysis is possible. The role of systemic treatment is not clear since only case reports on chemotherapy have been published to date 25 . Effects of sorafenib on brain metastases in HCC patients are not independently reported so far.…”

Pituitary metastasis of hepatocellular carcinoma presenting with panhypopituitarism: a case report

“…This was later confirmed by a blood test. On the other hand, the most common symptom of pituitary metastasis is DI [ 6 – 8 , 15 ], because the posterior lobe receives direct blood flow from systemic circulation [ 9 , 15 ]. However, Peppa et al described that the symptoms of metastasis to the pituitary gland are not specific and include fatigue, weight loss, dizziness, nausea, and vomiting.…”

“…Distinguishing metastasis to the pituitary gland from metastasis to the skull base (sphenoid sinus, cavernous sinus, and sella turcica) is very difficult because of the close proximity of these regions [ 15 ]. To establish a diagnosis, pathological confirmation is required.…”

“…For the treatment of metastatic pituitary tumors, Morita et al reported that there were no significant differences in survival times between surgical and nonsurgical treatments [ 9 ]. The vascularity of metastatic tumors is extremely rich; therefore, surgery is sometimes performed not only for palliation, but also for prevention of hemorrhage [ 15 ]. Additionally, surgery improves the quality of life and provides pathologic confirmation of the disease [ 11 ].…”