Isolated Progressive Enlargement of Head Mass as the First Symptom: A Rare Case Report of Cranial Metastasis of Hepatocellular Carcinoma and Literature Review

Background: This article presents a rare case of skull metastasis of primary hepatocellular carcinoma that manifests the isolated progressive enlargement of the head mass as the first symptom. Case presentation:A 65-year-old female patient presented an isolated painless mass in the head, which grew rapidly over the last month. Head CT revealed a 6.4 cm×5.6cm osteolytic destruction in the right parietal bone. MRI further revealed that the occupation was significantly enhanced in the T1 reinforced phase. The patient underwent total surgical resection. Postoperative pathology confirmed that the head mass was the skull metastasis from hepatocellular carcinoma (HCC). Conclusion: The case of skull metastasis from primary hepatocellular carcinoma is rare, and HCC patient with intracranial metastasis tends to have a rather poor prognosis. Surgical excision of the metastatic mass and radiotherapy can improve the life quality and prolong the survival time of the patient.

Calvarial Metastasis of Lung Cancer: a Case Report and Literature Review

Background: The skull is an uncommon site for bone metastasis of lung cancer. The most common type of skull metastasis is calvarial circumscribed intraosseous lesions. However, the use of targeted therapy or surgery remains controversial and the prognosis is poor.Case presentation: Skull metastasis was detected in a woman 4 years after resection of non-small cell lung cancer. Despite targeted drug therapy, the tumor continued to grow. However, the patient refused surgical treatment until she developed neurological deficit. An epidural effusion occurred after the operation. The patient was followed up for 16 months and her condition remained stable.Conclusion: Skull metastases of lung cancer can grow invasively. The current and previously reported cases highlight the importance of prompt removal of tumors located in the calvaria.

Not Your Typical “Lipoma”; An Unusual Case of Thyroid Cancer Presenting With a Skull Lesion

Background: Bone metastases from thyroid cancers tends to more commonly afflict the long bones, pelvis, ribs, vertebrae and sternum. Skull metastases are exceedingly rare being found in only ~2.5% of patients with thyroid cancer, more commonly in patients with Follicular thyroid carcinomas. We present an unusual case of thyroid cancer presenting with skull metastasis. Clinical Case: A 55 year- old male with a slowly growing skull lesion was referred to our center after an attempt to remove this scalp lesion was aborted as the lesion extended through a calvarial defect. This lesion was noted by the patient 1 year prior to presentation and was slowly growing in size. He opted for watchful monitoring as this was presumed to be a lipoma at the time. Imaging revealed a 6.4 x 4.6 x 6.3 cm lesion in the left parietal region with a large extra-axial and soft tissue components with intervening bone destruction as well as adjacent dural thickening. Differential for the lesion given the radiological appearance included meningioma, hemangiopericytoma, or an osseous/dural metastasis with an unclear primary malignancy. Excision of the extra-axial parietal lesion was consistent with metastatic thyroid carcinoma (follicular variant of papillary carcinoma). Further imaging revealed a multi nodular goiter with a prominent 6 cm left thyroid nodule. Patient had no obstructive symptoms. He underwent a total thyroidectomy with findings of a 6.8 cm minimally invasive follicular carcinoma with multifocal capsular invasion and a focus of vascular invasion. The right lobe revealed 1.5 cm classic PTC. Notably, margins were free of disease and cervical lymph nodes were negative for disease. Imaging revealed no other metastatic lesions. Patient received RAI after his total thyroidectomy and was started on suppressive doses of levothyroxine. He has been followed with annual MRI Brain, USG thyroid and Thyroglobulin levels and remains free of recurrence for the past 36 months. Conclusion: Thyroid cancer can present with skull metastasis without causing significant morbidity. This is a rare manifestation of disease and can be easily misdiagnosed. This case highlights the importance of keeping a broad differential when evaluating skull lesions.

Skull metastasis originating from adenocarcinoma of the esophagogastric junction

Esophageal carcinoma usually metastasizes to the liver, distant lymph nodes and lungs. The histological subtype may influence the metastatic sites, with bone metastasis being rather uncommon. This is a report on a patient who presented with adenocarcinoma of the esophagogastric junction and a concurrent skull metastasis.