Brain metastases from

hepatocellular carcinoma
Introduction
• Brain metastases from hepatocellular
carcinoma (BMHCC) are extremely rare,
occurring in approximately 1% of HCC patients
• Brain metastases (BM) are the most common
and devastating neurologic complications of
systemic cancer and occur in 20% to 40% of
advanced-stage cancers. BM mainly occurs in
patients with lung cancer (40-50%), breast
cancer (15-25%), and melanoma (5-20%) and
BM arising from HCC is extremely rare, with a
reported incidence ranging from 0.2% to 2.2%
Model for major mechanisms of HCC metastasis to the brain and T cell pass
through blood-brain barrier (BBB)
Brain metastases tend to occur in patients with
advanced HCC and distant metastasis is a
multistep process, often referred to as metastatic
cascade (Figure ​(Figure1)1) [21, 22]. As shown
in Table ​Table1,1, the interval from initial HCC
diagnosis to discovery of brain metastasis was
between10.5 and 29.5 months. Importantly, most
of the published series reported an interval <20
months, which is shorter than that patients with
brain metastases from lung cancer, breast
cancer and melanoma
Patient information
Name/Sure name: T.Tsetseg
Age - 62 years old
Gender - Female
Ethnicity - Mongolian

DS: Status post TAE due to brain metastasis

from HCC
Clinical presentation

The neurologic manifestations of HCC include

hepatic encephalopathy, paraneoplastic
syndromes, and metabolic encephalopathy.
The most frequent symptom is hepatic
encephalopathy caused by elevated serum
ammonia level
Symptoms
Fatigue
Less appetite
Abdominal pain
Losing weight
Vasculitis due to long term venous
chemotherapy
History of Present illness
She has started feeling some symptoms in
December, 2023 and she underwent Brain
MRI in January, 2024. It diagnosed tumor and
biopsy proved Brain metastasis from HCC.
After her diagnoses, she met surgeons and
they said that cancer was inoperable.
Past medical history
Hepatitis virus C
Liver cirrhosis
TACE treatment
Surgery
Biopsy result
Impression from CT scan
Impression
- HCC with LAPs
- Passive atelectasis of RLL due to pleural effusion of
right side
- Esophageal and splenic varices
- Splenomegaly
- Renal hypervascular lesions R/O Renal mts
- Abdomenal and pelvic cavity free fluid
- Pelvic LAPs
- Degenerative disc disease of L spine
- Osteolytic vertebral bone lesion R/O vertebral mts
Laboratory results
Complete blood count Comprehensive Metabolic panel
WBC - 5.79 *10^9/L Albumin - 27.4 g/l L
RBC - 4.17 *10^12/L Glucose - 5.40 mmol/l
HGB - 9.7 g/dL Creatinine - 54.2
PLT - 119 *10^9/mL Total protein - 58.7 g/l
AST - 21.3
ALT - 10.9
CRP- 20.3 mg/L
Treatment history
Thank you for your attention