[Case of skull metastasis from hepatocellular carcinoma at the site of skull fracture].
It has occasionally been reported that mechanical trauma and posttraumatic inflammation may promote metastasis from a primary tumor to the site of the trauma. However, the etiologies that contribute to the metastasis formation at the trauma site remain unknown. We describe here the first case of skull metastasis from hepatocellular carcinoma (HCC) revealing a growing subcutaneous mass at the site of skull fracture. A 58-year-old man had undergone surgical resection of a primary tumor in the liver 2 years previously and was in clinical remission. The patient fell head first off his bicycle and suffered a skull fracture in the squamous portion of the left temporal bone without ostelysis. Three months after the head trauma, he presented at our department with a growing lump on the left side of his head, and magnetic resonance (MR) imaging revealed an osteolytic tumor extending into the adjacent subcutaneous and epidural space. The tumor was at the same location as the skull fracture sustained in the bicycle accident. The mass lesion was radically resected with surrounding normal bone. The tumor formed a well-demarcated mass with osteolysis of the inner and outer skull tables, and the inner layer of the dura mater was intact. The histological diagnosis for the surgical specimen from the skull tumor was a HCC identical to the primary tumor. Immunohistochemically, the tumor cells were diffusely and strongly positive for vascular endothelial growth factor (VEGF) and basic fibrous growth factor (bFGF). It is well known that the extracellular matrix and cytokines are involved in the processes of not only bone healing but also metastasis formation. The present case suggests that several processes involved in bone healing modified the microenvironment and represent a possible cause of skull metastasis from primary tumor.
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