Solitary scalp metastasis – a rare presentation of hepatocellular carcinoma

Abstract

IntroductionHepatocellular carcinoma (HCC) is among the commonest cancers in the world. Metastasis is one of the most significant factors affecting prognosis. Common sites of extrahepatic metastases include lungs, regional lymph nodes and less commonly bone.Case presentationA 56-year-old male presented with a painless occipital scalp lump of three months duration, with recent rapid enlargement. His skull x-ray showed a lytic lesion over occipital bone and the contrast CT scan of the brain showed a scalp mass with destruction of the adjacent skull. Core biopsy of the lesion revealed a metastatic deposit from a hepatocellular carcinoma.ConclusionPrimary presentation with skeletal metastases are rare in HCC with only a few reported cases. Here we report a case of HCC presenting as a solitary scalp lump.

Skull metastases revealing a hepatocellular carcinoma: Case report and literature review

“…8 Through an exhaustive bibliographic review, we have noted 25 cases with the skull metastases as the inaugural symptom from HCC and 14 cases with the solitary skull metastases from HCC. [8][9][10][11] In our case skull metastases were the first symptom, but the extension assessment showed other skeletal metastases in sterum, and secondary hepatic nodules. Two pathways of metastatic dissemination can be discussed: the hematogenous pathway that disseminates cancer cells to the liver, lungs, and cerebral parenchyma, then the bone pathway through the venous plexus from Batson to the skull.…”

“…Clinical suspicion will lead to a biopsy with immunohistochemical study that will confirm the diagnosis, by finding the expression of anti-hepatocyte antibody. 11,12 A complete extension assessment, by brain MRI and thoracoabdominopelvic CT scan, will search for other secondary sites. 12 Therapeutic options remain palliative due to advanced stage of the disease, even in case of isolated cranial metastasis.…”

Lesion in Scalp and Skull as the First Manifestation of Hepatocellular Carcinoma

“…More recent studies have reported that the incidence of bone metastasis from HCC increased to 13% and that the most commonly involved sites were the vertebra, pelvis, rib, and skull [ 6 ]. Most HCC patients die of liver failure or internal bleeding without developing clinically apparent extrahepatic metastases [ 7 ].…”

Alopecia neoplastica as a sign of visceral malignancies: a systematic review

“…According to gender distribution of primary tumours, we obviously found that the 100% of patients with uterus cancer (8/ 8) 64,65,84 while in 24.8% (30/121) cases, the diagnosis was synchronous. 7,8,18,20,23,31,33,35,44,46,48,56,68,69,72,73,[76][77][78]81,84,87,93,95,96,99,102,110,111 The specific sites of primary tumours in each of these subgroups were reported in Table S1 (Supporting Information). Considering cases diagnosed after the primary tumour, they were mainly derived from breast and GI cancers (18/88 cases each); synchronous cases prevalently had a GI origin (10/30 cases), while cases diagnosed before the primary tumour were only three (one from GI, namely one thyroid and one lung cancer).…”

“…Regarding clinical appearance, AN was identified as a nodule, plaque and patch in 58% (69/119), 8,9,21,22,24,27,33,34,37-41,43,44,46,47,49- 2,6,7,11,[14][15][16][17][18][19][20]23,25,29,67,96 respectively; under the general term of a 'mass' in 16.8% (20/119) 28,32,35,42,45,48,58,59,71,73,80,81,83,87,95,106,110,111,114,117 and as an 'excoriated lesion' in 2.5% (3/119) of cases. 69,78,109 Specifically, breast cancer was mainly associated with patch lesions (9/20), followed by plaques and nodules (five and five out of 20, respectively).…”