A case of hepatocellular carcinoma with metastasis to thalamus confirmed by biopsy

The presence of extrahepatic metastasis is a critical factor when planning for hepatocellular carcinoma (HCC) treatment. As longer patient survival with HCC have been achieved, the number of patients with secondary intracranial metastases is likely to increase. A 57-year old man complained of gait disturbance and headache. He was diagnosed with HCC of both lobes of the liver and had undergone one session of transcatheter arterial chemoembolization treatment. Brain imaging revealed a hemorrhagic lesion at the right thalamus. To decompress the intracranial pressure and confirm the etiology of intracranial hemorrhage, an endoscope was introduced into the third ventricle through the foramen of Monro. The tumor was identified on floor of third ventricle, on the right side, and appeared to be hypervascular and hard in consistency. Using the endoscope forceps, a biopsy was performed and an external ventricular drainage catheter was inserted. The brain pathology confirmed metastatic HCC. This is the first report of a biopsy-proven metastasis of HCC to thalamus.ope