Solitary skull metastasis mimicking a meningioma with dural tail sign as the initial presentation of hepatocellular carcinoma: A case report and a brief review

Metastasis to the skull often occurs in patients with lung, breast, and prostate cancer. However, solitary skull metastasis mimicking a meningioma with dural tail sign from hepatocellular carcinoma (HCC) is exceedingly rare. We report a 49-year-old male who is a hepatitis B virus carrier presenting with an enlarging subcutaneous mass at the right occipital region for more than 5 months. The brain CT and MRI showed a huge extra-axial mass at the right temporo-parieto-occipital region with dural tail sign and bony destruction. The pre-operative diagnosis was an atypical meningioma. We performed a craniectomy along with tumor removal, and the pathological report was metastatic HCC. The patient had titanium mesh cranioplasty two weeks later. Subsequent treatments (sorafenib plus focal radiation) were arranged. The post-operative brain MRI at 3 months follow-up showed no recurrence. Further aggressive treatment for his HCC was arranged. In the English literature (PubMed search), 19 cases of skull metastasis from HCC as the initial presentation were reported in the recent decade. Among them, only seven cases had dural involvement. Whether these patients received aggressive or palliative treatments following the diagnosis of metastatic HCC depended on the disease stage and severity of the underlying liver disease. Solitary skull metastasis of HCC mimicking a meningioma is very rare but should be considered as a differential diagnosis in patients with chronic hepatitis B presenting with scalp lesion. Treatment should be individualized to alleviate symptoms, improve quality of life, and increase survival.