Leptomeningeal metastasis from hepatocellular carcinoma with other unusual metastases: a case report

Zhenyu Pan, Guozi Yang, Tingting Yuan, Xiaochuan Pang, Yongxiang Wang, Limei Qu, Lihua Dong, Zhenyu Pan, Guozi Yang, Tingting Yuan, Xiaochuan Pang, Yongxiang Wang, Limei Qu, Lihua Dong

Abstract

Background: Leptomeningeal metastasis, which results from metastasis of tumors to the arachnoid and pia mater, can lead to the dissemination of tumor cells throughout the subarachnoid space via the cerebral spinal fluid, and frequently with a poor prognosis. The primary tumor in adults is most often breast cancer, lung cancer, or melanoma. Although leptomeningeal metastasis due to cholangiocarcinoma has been reported, to the best of our knowledge there is no cytologically confirmed report of leptomeningeal metastasis from hepatocellular carcinoma.

Case presentation: We herein report a case of leptomeningeal metastasis from hepatocellular carcinoma in a 53-year-old woman with concomitant systemic metastases to the lung, bone, brain, kidney, adrenal gland, subcutaneous tissues, and abdominal pelvis. The neurological symptoms of the patient were relieved after treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy.

Conclusion: To our knowledge this is the first report of leptomeningeal metastasis from hepatocellular carcinoma confirmed by cytology. Treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy was effective.

Figures

Figure 1
Figure 1
Abdominal CT. A-D) Plain scanning and triphasic contrast-enhanced scanning of lesions in the left liver lobe. E) Adrenal gland and kidney lesions. F) Lesions in the subcutaneous fat layer.
Figure 2
Figure 2
Imaging findings. A) Chest CT showed lesions in the inferior lobe of the right lung. B) Pelvic CT showed pelvic nodules. C) Bone scan showed increased radioactivity in the right femur. D) MRI scan of the head showed multiple lesions in the brain, with lesions in the right side of the cerebellopontine angle.
Figure 3
Figure 3
Pathology slides of the resected specimen and CSF cytology slides. A) Biopsy of subcutaneous tumor in the right shoulder. B) Biopsy of resected left liver lobe lesions. C) Cytological examination of CSF. Liquid-based technology, pap staining (400×).

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