Edwina Vasantha William1, Nagalekshmi Ganesan2, Uma Balakrishnan3, Karthikeyan Rajashekar4
Hepatocellular Carcinoma (HCC) is one of the more common cancers in the world. Distant metastasis is one of the most important prognostic factors. Extrahepatic metastases most commonly involve the lungs, regional lymph nodes and bone is less common.
A 70-year-old female presented with a painless parieto-occipital scalp lump of 10 days duration with rapid enlargement. Her skull x-ray showed a lytic lesion over occipital bone and the contrast CT scan of the brain showed a scalp mass with destruction of the adjacent skull. FNAC of the lesion revealed a metastatic deposit from an unknown primary. Contrast CT of the abdomen revealed a liver mass, which ultrasound-guided cytology revealed to be hepatocellular carcinoma. Patient was treated with sorafenib.
Primary presentation with skeletal metastases are rare in HCC with only a few reported cases. Even then, a skull metastasis from HCC should be considered in the differential diagnosis in patients with subcutaneous scalp swelling and osteolytic defects on x-ray. Here, we report a case of HCC presenting as a solitary scalp lump.