A Case of Metastatic Hepatocellular Carcinoma Who Initially Presented with a Sphenoid Sinus Lesion

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  • 蝶形骨洞内の病変から診断された肝細胞癌例
  • チョウケイ ホネドウ ナイ ノ ビョウヘン カラ シンダン サレタ カン サイボウ ガンレイ

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Abstract

<p>We report a rare case of a patient with a skull base metastasis secondary to hepatocellular carcinoma, who presented with visual impairment as the initial presenting symptom.</p><p>A 64-year-old male patient with no symptoms and no history of viral hepatitis was diagnosed as having liver and skull base tumors after being detected, during a medical examination, as having a lung tumor. A few weeks later, he became blind, but there were no ocular motility disorders. Examination revealed a tumor causing bone destruction in the sphenoid sinus, orbital tip and middle skull base, and PET-CT revealed FDG accumulation in the same area. We performed a biopsy of the sphenoid sinus lesion under endoscopic guidance, without any major bleeding, and histopathology revealed a metastatic hepatocellular carcinoma. The patient was treated by TACE, performed twice, for the liver lesions and radiation therapy for the skull base lesions, followed by oral sorafenib treatment for 8 months. Sorafenib was then switched to regorafenib because of PD. Subsequently, we switched the drug to lenvatinib and then ramucirumab, and administered additional stereotactic radiation therapy (SRT) because of visual impairment on the opposite side, but the patient died 3 years 7 months later of uncontrollable rectal bleeding. We think that the skull base metastases occurred in the bone, and not in the cavernous sinus, because the patient had only visual impairment not associated with any ocular motility disorder, disappeared as a first symptoms. Although molecular-targeted drugs that have emerged as treatments for hepatocellular carcinoma have been demonstrated to prolong the survival, radiation therapy is used as local therapy to maintain the QOL in patients with skull base lesions.</p>

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