CLINICAL AND RADIOLOGICAL PICTURES OF HEPATOCELLULAR-CARCINOMA WITH INTRACRANIAL METASTASIS

Hepatocellular carcinoma (HCC) with extrahepatic spreading is not unco mmon. In order to delineate the clinical and radiological pictures of HCC with intracranial metastasis, 33 documented cases were analysed. E ighteen had brain parenchymal metastasis without skull involvement; th e other 15 cases disclosed skull metastasis with brain invasion. The u nderlying HCC are mainly of expanding (13/33, 39.4%) and multifocal (1 3/33, 39.4%) types. Eighteen cases (18/33, 54.5%) had mental changes n ot related to hypoglycaemia or hepatic encephalopathy. Eighteen cases (18/20, 90%) disclosed hyperdense mass lesions by non-contrast compute d tomography (CT) scans and 17 cases showed homogeneous enhancement (1 7/22, 77.3%) by post-contrast CT images. In the non-skull involved gro up, five cases (5/12, 41.7%) disclosed ring-shape enhancement and 14 c ases (14/16, 87.5%) had perifocal oedema, which were not seen in the s kull involved group. Eight cases (8/33, 24.2%) presented as intracereb ral haemorrhage. Twelve (12/33, 36.4%) died of brain herniation. Most (14/18, 77.8%) non-skull involved cases had simultaneous lung metastas is without bony metastasis, while the skull involved group often (10/1 5, 66.7%) disclosed extracranial bony metastasis without lung metastas is. The difference in extracranial metastasis was statistically signif icant (P < 0.05). The multivariate survival analysis disclosed that lo wer lactate dehydrogenase level (less than or equal to 316 Un, P = 0.0 29) and treatments (surgery or radiation, P = 0.001) were positively a ssociated with longer survival. In conclusion, HCC with intracranial m etastasis is symptomatic and life-threatening. Half the cases may come from pulmonary metastasis and the other half may be from bony metasta sis. Brain irradiation or surgery can prolong their survival.