[1]刘援援,周志华,胡帅,等.以颅骨转移为首发表现的肝癌1例[J].中国临床神经外科杂志,2024,29(10):638-640.[doi:10.13798/j.issn.1009-153X.2024.10.016]
　LIU Yuan-yuan,ZHOU Zhi-hua,HU Shuai,et al.A case of hepatocellular carcinoma with skull metastasis as the first manifestation[J].,2024,29(10):638-640.[doi:10.13798/j.issn.1009-153X.2024.10.016]
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以颅骨转移为首发表现的肝癌1例()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年10期
页码:
638-640
栏目:
个案报道
出版日期:
2024-10-30

文章信息/Info

Title:
A case of hepatocellular carcinoma with skull metastasis as the first manifestation
文章编号:
1009-153X（2024）10-0638-03
作者:
刘援援; 周志华; 胡帅; 王豪升; 袁俊; 周劲旭
237000安徽六安，安徽医科大学附属六安医院神经外科（刘援援）；214044江苏无锡，联勤保障部队第904医院神经外科（刘援援、胡帅、王豪升、袁俊、周劲旭），病理科（周志华）
Author(s):
LIU Yuan-yuan1; 2;  ZHOU Zhi-hua3;  HU Shuai2;  WANG Hao-sheng2;  YUAN Jun2;  ZHOU Jin-xu2
1. Department of Neurosurgery, The Lu'an Hospital Affiliated to Anhui Medical University, The Lu'an People's Hospital, Lu'an 237000, China; 2. Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi 214040, China; 3. Department of Pathology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi 214040, China
关键词:
颅骨转移瘤; 原发性肝癌; 显微手术
Keywords:
Skull metastases;  Primary hepatocellular carcinoma;  Microsurgery
分类号:
R 739.91; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2024.10.016
文献标志码:
B
摘要:
肝癌是最常见的实体恶性肿瘤之一，病死率较高，发生肝外转移的时间窗短，通常发生在肿瘤的晚期，预后不佳。原发性肝癌颅骨转移是一种罕见的转移性肿瘤，以孤立性头部包块为首发症状者更为罕见。本文报道1例65岁女性病人，因右顶部肿物进行性增大就诊，头颅CT、MRI显示右顶骨占位，大小约6.4×5.6 cm，骨质破坏严重。完善术前检查后，在全麻下行右顶部占位切除术。术中见肿瘤位于硬脑膜外，侵犯上矢状窦。完整切除肿瘤，术后病理结果为转移性肝癌。术后腹部CT检查发现肝脏占位。但术后肝脏肿瘤标记物（甲胎蛋白、癌胚抗原、糖类抗原199及125）在正常范围。术后随访4个月，颅骨转移未见复发。这提示头部肿物短期内迅速增大时，应考虑到颅骨转移的可能。
Abstract:
Hepatocellular carcinoma is one of the common solid malignant neoplasms, associated with a high mortality rate. Extrahepatic metastasis typically occurs in the advanced stage of the tumor, featuring a narrow time window and an unfavorable prognosis. Skull metastasis of primary hepatocellular carcinoma represents a rare metastatic lesion, and the manifestation of an isolated skull mass as the initial symptom is even more infrequent. This paper presents a case of a 65-year-old female patient who sought medical attention due to the progressive enlargement of a mass on the right parietal region. Cranial CT and MRI examinations disclosed a space-occupying lesion in the right parietal bone, approximately 6.4 × 5.6 cm in size, accompanied by severe bone destruction. After the completion of preoperative assessment, a resection of the right parietal space-occupying lesion was conducted under general anesthesia. Intraoperatively, it was identified that the tumor was located outside the dura mater and invaded the superior sagittal sinus. The tumor was successfully and completely excised, and the postoperative pathological diagnosis confirmed it as metastatic hepatocellular carcinoma. Postoperative abdominal CT scan revealed a liver space-occupying lesion; however, postoperative liver cancer-related tumor markers (alpha-fetoprotein, carcinoembryonic antigen, carbohydrate antigen 199, and 125) were all within the normal range. The patient was followed up for 4 months postoperatively, and no recurrence of skull metastasis was noted. This case implies that when a head mass undergoes rapid growth within a short period, the possibility of skull metastasis should be contemplated.

参考文献/References:

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[2] BROWN ZJ, TSILIMIGRAS DI, RUFF SM, et al. Management of hepatocellular carcinoma: a review [J]. JAMA Surg, 2023, 158(4): 410-420.
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[4] UEI H, TOKUHASHI Y, MASEDA M, et al. Surgical management of coincidental metastases to upper cervical spine and skull from hepatocellular carcinoma: a case report [J]. J Int Med Res, 2018, 46 (11): 4852-4859.
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[6] LEI Q, CHEN H, ZHENG H, et al. Zygomatic bone metastasis from hepatocellular carcinoma and the therapeutic efficacy of apatinib: a case report and literature review [J]. Medicine (Baltimore), 2019, 98 (18): e14595.
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相似文献/References:

[1]缪逸涛　杨　军　陈　庚　洪新雨.肝癌椎管内硬脊膜外转移1例[J].中国临床神经外科杂志,2019,(01):62.[doi:10.13798/j.issn.1009-153X.2019.01.020]
[2]马迎辉　胡　胜　吕华荣.原发性肝癌硬脑膜外转移1例[J].中国临床神经外科杂志,2020,(09):656.[doi:10.13798/j.issn.1009-153X.2020.09.032]

备注/Memo

备注/Memo:
（2022-06-08收稿，2024-04-03修回）
通信作者：周劲旭，Email：zxh071109@sina.cn
更新日期/Last Update: 2024-10-30