Spontaneous epidural hematoma from skull base metastasis of hepatocellular carcinoma

Abstract

We report a case of an acute spontaneous epidural hematoma (EDH) due to skull base metastasis in a 46-year-old male patient with hepatocellular carcinoma (HCC). The patient presented with the acute onset of severe headache followed by unconsciousness, and computed tomography showed a large EDH in the right temporal and parietal lobes with midline shift. Emergency evacuation of the EDH was performed, and the hemorrhage was determined to be secondary to skull base metastasis of HCC.

Keywords: Epidural hematoma; Hepatocellular carcinoma; Skull base metastasis.

Fig. 1

Non-contrast brain tomography and bone setting image. A : Brain computerized tomography shows epidural hematoma in the right temporal base with midline shift, obliteration of basal cistern, and enlarged left temporal horn of lateral ventricle. B : Decreased bone density in the greater wing of the right sphenoid bone (arrow) compared with the contralateral part is suspected in the bone setting image.

Fig. 2

Histologic features of tumor. The tumor shows thick trabecular growth pattern with intercellular canaliculi resembling liver cell plates and sinusoids. The tumor cells maintain a polygonal shape and have abundant granular eosinophilic cytoplasm, round vesicular nuclei and prominent nucleoli (H&E, ×200).

Fig. 3

The immunohistochemical finding. The tumor cells show strong cytoplasmic immunoreactivity for α-fetoprotein.