Distant metastasis of hepatocellular carcinoma to Meckel’s cave and cranial nerves:A case report and review of literature

作     者：Soo Ki Kim Takako Fujii Ryouhei Komaki Hisato Kobayashi Toyokazu Okuda Yumi Fujii Takanobu Hayakumo Kanako Yuasa Masahiro Takami Aya Ohtani Yuka Saijo Yu-Ichiro Koma Soo Ryang Kim 

作者机构：Department of GastroenterologyKobe Asahi HospitalKobe 653-0801HyogoJapan Division of NeurologyKobe University Graduate School of MedicineKobe 650-0017HyogoJapan Department of RadiologyKobe Asahi HospitalKobe 653-0801HyogoJapan Department of PharmacyKobe Asahi HospitalKobe 653-0801HyogoJapan Department of PathologyKobe University Graduate School of MedicineKobe 650-0017HyogoJapan 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2021年第13卷第6期

页      面：709-716页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Meckel’s cave Abducens nerve Trigeminal nerve Hepatocellular carcinoma Magnetic resonance imaging Case report 

摘      要：BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma(HCC),and most patients die of liver failure attributed to the tumor supplanting the liver.Conversely,the brain is a less common metastatic site.CASE SUMMARY We describe a rare case of hepatitis C virus-related multiple HCC metastasizing to the cavernous sinus,Meckel’s cave,and the petrous bone involving multiple cranial nerves in an 82-year-old woman.At admission imaging studies including Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(MRI)revealed multiple HCC nodules in both right and left lobes.Ultrasound guided biopsy of the left lobe revealed moderately differentiated HCC.Molecular targeted therapy with Lenvatinib(8 mg/d for 94 d,per os)and Ramucirumab(340 mg/d and 320 mg/d,two times by intravenous injection)were administered for 4 mo,resulting in progression of the disease.Three months after the start of molecular target therapy,the patient presented with symptoms of hyperalgesia of the right face and limited abduction of the right eye,indicating disturbances in the right trigeminal and abducens nerves.Brain MRI disclosed a mass involving the cavernous sinus,Meckel’s cave and the petrous bone.Contrast-enhanced MRI with gadolinium-chelated contrast medium revealed a well-defined mass with abnormal enhancement around the right cavernous sinus and the right Meckel’s cave.CONCLUSION The diagnosis of metastatic HCC to the cavernous sinus,Meckel’s cave,and the petrous bone was made based on neurological findings and imaging studies including MRI,but not on histological examinations.Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.