Hepatocellular carcinoma with intracranial metastasis in a Japanese macaque (Macaca fuscata)

Hepatocellular carcinomas in captive prosimians

We performed a retrospective examination of spontaneous hepatocellular carcinomas (HCCs) (primary and metastatic tumors) in 14 captive prosimians brought to the Veterinary Medical Diagnostic Laboratory in North Carolina State University over a period of 11 years (2003 to 2014) to characterize the tumors. These animals are endangered primates; a better understanding of the main fatal neoplasms is crucial. In addition to the histologic evaluation, an immunohistochemical study was also performed, using a hepatocyte marker (hepatocyte paraffin 1 [HepPar-1]) and 2 cholangiocyte markers (keratin 7 [K7] and keratin 19 [K19]), in an attempt to identify a specific profile for HCCs with metastatic behavior. Six of the 14 HCCs had pulmonary metastases. The most frequent histopathological findings were a trabecular pattern (14/14, 100%), presence of multinucleated cells (12/14, 85.7%), and foci of extramedullary hematopoiesis (9/14, 64.3%). The mitotic count was significantly higher in the metastatic HCCs (P < .05). HepPar-1 was detected in all primary and metastatic HCCs, with a strong intensity of staining. Labeling for K7 and K19 was positive in 12 HCCs (85.7%) and 1 HCC (7.1%), respectively. Contrary to the less aggressive HCCs, most of the metastatic HCCs (5/6) expressed K7 in more than 15% of cells. The percentage of K7-positive neoplastic hepatocytes was significantly higher in metastatic HCCs. This study suggests that K7 might be a prognostically relevant marker in HCCs of captive prosimians.

Skull Metastasis from the Liver: Case Report and Literature Review

BACKGROUND

Calvarial metastasis from liver cirrhosis in the absence of a primary focus is exceptionally rare. Few reports of metastases from hepatocellular carcinoma of an unknown primary focus have been published.

CASE DESCRIPTION

A 66-year-old man with a history of Schistosoma japonicum infection presented to our hospital with a mass over the left occipital region associated with headache and dizziness. Imaging revealed a 6 × 5-cm lesion supplied principally by the left occipital artery. The metastatic tumor was removed via super-selective embolization and craniotomy. Pathology revealed that circulating tumor cells from the liver had metastasized to the calvaria. Postoperatively, no primary foci was found over 9 months of follow-up.

CONCLUSIONS

A calvarial mass may be an initial manifestation of hepatocellular carcinoma. Early diagnosis is important. A calvarial metastasis from the liver, although very rare, should be included in the differential diagnosis of a patient with both cirrhosis and skull mass.