# Calvarial Metastasis as the Initial Presentation in Hepatocellular Carcinoma: A Rare Entity

## TL;DR

A rare case of liver cancer initially showing as a skull tumor is presented, highlighting the importance of advanced imaging and multidisciplinary care.

## Contribution

This case report adds to the limited literature on hepatocellular carcinoma presenting as calvarial metastasis.

## Key findings

- The patient had a calvarial lesion extending into the orbit and causing visual symptoms.
- PET imaging revealed extensive liver metastases, confirming advanced hepatocellular carcinoma.
- Treatment included Lenvatinib, radiotherapy, and supportive care, emphasizing a multidisciplinary approach.

## Abstract

Hepatocellular carcinoma (HCC) presenting as calvarial metastasis (CM) is a rare situation with limited reports in literature. We present a case of a 64-year-old gentleman, who presented with an 8-month history of swelling on the right forehead, associated with decreased vision and size of the right eye. Magnetic resonance imaging revealed a partially hemorrhagic lesion in the right frontal bone, extending into the scalp and causing a midline shift, with intra-orbital and intraconal extension. Positron emission tomography showed multiple bi-lobar liver metastases. The patient was diagnosed with hepatitis B–associated hepatocellular carcinoma on biopsy and was started on dexamethasone, anti-epileptic prophylaxis, and Lenvatinib. He also received focal radiotherapy for the CM. Advanced imaging techniques were crucial in diagnosing the disease’s extent. The patient’s management, involving pharmacological therapy, radiotherapy, and supportive care, highlights the need for a multidisciplinary approach in treating advanced malignancies.