# Skull Metastasis With Orbital Invasion as a Primary Manifestation of Hepatocellular Carcinoma

## TL;DR

This paper reports a rare case where liver cancer first showed up as a skull tumor and eye area spread, instead of typical liver symptoms.

## Contribution

The novelty is presenting skull and orbital metastasis as the first sign of hepatocellular carcinoma.

## Key findings

- Skull metastasis occurred in less than 1.6% of HCC cases.
- Orbital invasion was an initial manifestation in this reported case.
- Typical HCC symptoms usually relate to the liver, not the skull or eyes.

## Abstract

Hepatocellular carcinoma (HCC) is a common worldwide cancer with a poor prognosis despite treatment advancements. Patients typically exhibit signs and symptoms pertaining to the liver. Extrahepatic metastasis of HCC is documented to be as low as 5% of cases. Bone metastasis ranks third following lungs and regional lymph nodes. The typical locations for bone metastasis include the vertebral column, pelvis, femora, and ribs, with skull metastasis, being reported in less than 1.6% of cases. Herein, we describe a case of HCC presenting with skull metastases and orbital invasion as the initial manifestation.