Abstract
Brain metastases from hepatocellular carcinoma (HCC) are rare and usually occur in patients with advanced systemic disease. Cranial metastasis as the first manifestation of previously undiagnosed HCC is particularly uncommon.
We report a 70-year-old HCV-positive man with a rapidly growing cranial mass initially considered to be a lipoma. Within two months, the lesion reached an enormous size, with extensive cranial destruction and significant intracranial extension. Further diagnostic work-up revealed a previously unknown HCC without other detectable distant metastases. Complete surgical resection and cranioplasty were performed, and histopathology confirmed metastatic HCC. Five months after surgery, there was no evidence of local recurrence, although a new scapular lesion suspicious for metastatic disease subsequently developed and the patient declined further treatment.
Giant cranial metastasis may rarely represent the first manifestation of HCC. Surgical resection can provide effective local control, particularly in large symptomatic lesions with significant mass effect. Given the rarity of this condition and the absence of standardised treatment guidelines, an individualised multidisciplinary approach remains essential.
