CASE REPORT article
Front. Oncol.
Sec. Neuro-Oncology and Neurosurgical Oncology
This article is part of the Research TopicAdvancing Multidisciplinary Approaches in Skull-Base Tumor ManagementView all 11 articles
Clival metastasis of hepatocellular carcinoma: a case report of a rare skull-base malignancy
Provisionally accepted
- 1Department of neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- 2Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- 3Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- 4Faculty of Medicine, Institute of Pathology, University of Ljubljana, Korytkova ulica 2, 1000 Ljubljana, Slovenia., Ljubljana, Slovenia
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Introduction: Hepatocellular carcinoma is the most common neoplasm of the liver. It metastasizes mainly to local lymph nodes, lungs, adrenal glands, vertebrae, pelvis, ribs and long bones. Metastasis to the clivus is extremely rare. Only a few cases have been described in the literature. Therefore, there is currently no clear consensus on the optimal treatment: biopsy only or maximum safe removal. Case report: We present a 68-year-old lady who presented with dysfunction of the 6th and 12th cranial nerves. Imaging showed tumour formation in the clivus, most likely a metastasis. Further diagnostics revealed no clear primary tumour. The patient therefore underwent surgery for local decompression and simultaneous biopsy for pathohistologic examinations. These showed that the most likely metastasis was a hepatocellular carcinoma. Subsequent diagnostics revealed highly elevated alpha-feto protein levels and liver MR revealed a suspected multifocal hepatocellular carcinoma only after correlation with the pathohistologic findings. One month after surgery, the condition suddenly worsened due to severe local recurrence and hemorrhage. This was followed by palliative oncological treatment with whole head irradiation. Conclusion: In the case of a suspected clivus metastasis of unknown origin, it is reasonable to take tumour markers. This increases the likelihood of an appropriate diagnosis and avoids unnecessary and risky surgery. If all tests are inconclusive, a biopsy of the lesion is the diagnostic gold standard. The treatment of metastatic disease in the clivus (in our case a hepatocellular carcinoma) remains palliative.
Keywords: Hepatocellular Carcinoma, Clivus, metastasis, Endoscopic endonasal surgery, Casereport
Received: 26 Jan 2025; Accepted: 22 Dec 2025.
Copyright: © 2025 Felbabić, Bošnjak, Vozel, Urbančič and Bošnjak. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tomislav Felbabić
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