Brain Tumor Res Treat.  2015 Apr;3(1):48-51. 10.14791/btrt.2015.3.1.48.

Concomitant Subdural Hemorrhage and Intracerebral Hemorrhage due to Brain Metastasis of the Hepatocellular Carcinoma

• Jang SY
• Kim CH
• Cheong JH
• Kim JM

• KMID: 1882011
• DOI: http://doi.org/10.14791/btrt.2015.3.1.48

Abstract

Hemorrhagic metastatic brain tumors of hepatocellular carcinoma (HCC) are rare and have been mostly presented as intracranial hemorrhage (ICH). A 51-year-old male patient presented with sudden altered level of consciousness. He suffered from HCC since 2010 and transarterial chemoembolization was performed three times for HCC. The brain computed tomography (CT) scans revealed subdural hematoma (SDH) in the right fronto-temporal area and 6.0x3.5 cm sized ICH in the right parieto-occipital lobe. Brain angiographic CT scans demonstrated that the hemorrhagic lesions did not include any enhancing lesions and vascular abnormalities. We undertook a decompressive craniectomy and evacuation of the acute SDH and ICH. During evacuation of ICH, the yellowish mass was observed in the cortical surface of the right occipital lobe. Pathological examination displayed the findings of metastatic brain tumor from HCC. Metastatic brain tumors should be considered in the differential diagnosis as a cause of spontaneous SDH with ICH.

Keyword

Neoplasm metastasis; Carcinoma, hepatocellular; Intracranial hemorrhages; Hematoma, subdural

MeSH Terms

Brain Neoplasms
Brain*
Carcinoma, Hepatocellular*
Cerebral Hemorrhage*
Consciousness Disorders
Decompressive Craniectomy
Diagnosis, Differential
Hematoma, Subdural*
Humans
Intracranial Hemorrhages
Male
Middle Aged
Neoplasm Metastasis*
Occipital Lobe
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Computed tomographic scan of brain demonstrating subdural hemorrhage in the right fronto-temporal area and 6.0×3.5 cm sized intracerebral hemorrhage in the right parieto-occipital lobe.

• 

  Fig. 2 Brain angiographic computed tomographic scans showing no enhanced lesion or vascular abnormality in the hemorrhagic area.

• 

  Fig. 3 Gross photography of tissue for biopsy was yellowish and brown.

• 

  Fig. 4 Photomicrographs of the surgical specimen. A: The result of hematoxylin and eosin staining shows pleomorphism, trabecular pattern of cells with abundant cytoplasm and prominent nucleoli. Numerous mitotic figures are also observed (×400). B: The cells were diffusely reactive in the immunohistochemical staining to hepatocyte antigen (×400).

Reference

1. Wakisaka S, Tashiro M, Nakano S, Kita T, Kisanuki H, Kinoshita K. Intracranial and orbital metastasis of hepatocellular carcinoma: report of two cases. Neurosurgery. 1990; 26:863–866.

2. Choi HJ, Cho BC, Sohn JH, et al. Brain metastases from hepatocellular carcinoma: prognostic factors and outcome: brain metastasis from HCC. J Neurooncol. 2009; 91:307–313.

3. Kuga Y, Waga S, Itoh H. Intracranial hemorrhage due to brain metastasis from hepatocellular carcinoma--case report. Neurol Med Chir (Tokyo). 1990; 30:768–771.

4. Endo M, Hamano M, Watanabe K, Wakai S. [Combined chronic subdural and acute epidural hematoma secondary to metastatic hepatocellular cancer: case report]. No Shinkei Geka. 1999; 27:331–334.

5. Hayashi K, Matsuo T, Kurihara M, Daikoku M, Kitange G, Shibata S. Skull metastasis of hepatocellular carcinoma associated with acute epidural hematoma: a case report. Surg Neurol. 2000; 53:379–382.

6. Kim BG, Yoon SM, Bae HG, Yun IG. Spontaneous intracranial epidural hematoma originating from dural metastasis of hepatocellular carcinoma. J Korean Neurosurg Soc. 2010; 48:166–169.

7. Lee KW, Chung DS, Huh PW, Hong YK, Rha HK, Kang JK. Intracranial metastasis of hepatocellular carcinoma associated with epidural hematoma: a case report. J Korean Neurosurg Soc. 1996; 25:1738–1742.

8. McIver JI, Scheithauer BW, Rydberg CH, Atkinson JL. Metastatic hepatocellular carcinoma presenting as epidural hematoma: case report. Neurosurgery. 2001; 49:447–449.

9. Nakagawa Y, Yoshino E, Suzuki K, Tatebe A, Andachi H. Spontaneous epidural hematoma from a hepatocellular carcinoma metastasis to the skull--case report. Neurol Med Chir (Tokyo). 1992; 32:300–302.

10. Nakao N, Kubo K, Moriwaki H. Cranial metastasis of hepatocellular carcinoma associated with chronic epidural hematoma--case report. Neurol Med Chir (Tokyo). 1992; 32:100–103.

11. Woo KM, Kim BC, Cho KT, Kim EJ. Spontaneous epidural hematoma from skull base metastasis of hepatocellular carcinoma. J Korean Neurosurg Soc. 2010; 47:461–463.

12. Tanaka Y, Kawaguchi J, Hayashi H, et al. Nontraumatic subdural hematoma secondary to dural metastasis of hepatocellular carcinoma: case report and review of the literature. Jpn J Stroke. 2004; 26:382–386.

13. Han JH, Kim DG, Park JC, Chung HT, Paek SH, Chung YS. Little response of cerebral metastasis from hepatocellular carcinoma to any treatments. J Korean Neurosurg Soc. 2010; 47:325–331.

14. Goto T, Dohmen T, Miura K, et al. Skull metastasis from hepatocellular carcinoma with chronic hepatitis B. World J Gastrointest Oncol. 2010; 2:165–168.

15. Friedman HD. Hepatocellular carcinoma with central nervous system metastasis: a case report and literature review. Med Pediatr Oncol. 1991; 19:139–144.

16. Lee JP, Lee ST. Hepatocellular carcinoma presenting as intracranial metastasis. Surg Neurol. 1988; 30:316–320.

17. Loo KT, Tsui WM, Chung KH, Ho LC, Tang SK, Tse CH. Hepatocellular carcinoma metastasizing to the brain and orbit: report of three cases. Pathology. 1994; 26:119–122.

18. Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery. 1982; 10:437–444.

19. Yang WT, Yeo W, Leung SF, Chan YL, Johnson PJ, Metreweli C. MRI and CT of metastatic hepatocellular carcinoma causing spinal cord compression. Clin Radiol. 1997; 52:755–760.

20. Russell DS, Cairns H. Subdural false membrane or haematoma (pachymeningitis interna haemorrhagica) in carcinomatosis and sarcomatosis of the dura mater. Brain. 1934; 57:32–48.

21. Cho DC, Yi HJ, Ko Y, Oh SJ, Lee SR, Paik SS. Recurrent metastatic hepatocellular carcinoma presenting as consecutive "mirror image" intracerebral haematomas. J Clin Neurosci. 2005; 12:699–702.

22. Ambiavagar PC, Sher J. Subdural hematoma secondary to metastatic neoplasm: report of two cases and a review of the literature. Cancer. 1978; 42:2015–2018.