Occipital Lobe Metastasis of Hepatocellular Carcinoma Presenting as Homonymous Hemianopia

Hye Jin Lee; Young Hee Maeng; Jinho Jeong; You-Nam Chung; Chang Sub Lee; Byung-Cheol Song

doi:10.3341/jkos.2017.58.4.488

Journal List > J Korean Ophthalmol Soc > v.58(4) > 1010754

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Lee, Maeng, Jeong, Chung, Lee, and Song: Occipital Lobe Metastasis of Hepatocellular Carcinoma Presenting as Homonymous Hemianopia

Original Article

J Korean Ophthalmol Soc 2017;58(4):488-492.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.4.488

Occipital Lobe Metastasis of Hepatocellular Carcinoma Presenting as Homonymous Hemianopia

Hye Jin Lee, M.D.^1,, Young Hee Maeng, MD, PhD², Jinho Jeong, MD, PhD¹, You-Nam Chung, MD, PhD³, Chang Sub Lee, MD, PhD³, Byung-Cheol Song, MD, PhD⁴

^¹Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea

^²Department of Pathology, Jeju National University School of Medicine, Jeju, Korea

^³Department of Neurosurgery, Jeju National University School of Medicine, Jeju, Korea

^⁴Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea

Address reprint requests to Hye Jin Lee, MD Department of Ophthalmology, Jeju National University Hospital, #15 Aran 13-gil, Jeju 63241, Korea Tel: 82-64-717-1142, Fax: 82-64-717-1102 E-mail: ilovelhj@hanmail.net

Received 8 December 201610 January 2017 Accepted 28 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report brain metastasis of hepatocellular carcinoma presenting as homonymous hemianopia.

Case summary

A 51-year-old female with a history of hepatectomy and diagnosis of hepatocellular carcinoma (HCC) 19 months earlier was referred to our neuro-ophthalmology clinic for evaluation due to headache and decreased visual acuity over the past several months. Best visual acuity was 20/20, and the results of all other aspects of our examination were normal except Humphrey automatic perimetry, which showed complete left homonymous hemianopia. Brain magnetic resonance imaging showed a large mass in the right occipital lobe. Craniotomy and removal of tumor were performed. HCC was confirmed by histo-pathologic examination.

Conclusions

Metastasis of hepatocellular carcinoma to the occipital lobe is extremely rare but can present as homonymous hemianopia. Therefore, clinicians should be aware of this when examining a patient with a history of HCC.

Keywords: Brain tumor, Hepatocellular carcinoma, Homonymous hemianopia, Intracranial metastasis, Occipital lobe

References

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Figure 1.

Humphrey visual field shows complete left homonymous hemianopia at the initial presentation. Humphrey visual field shows complete left homonymous hemianopia with macular splitting at the initial presentation.

Figure 2.

Brain magnetic resonance imaging shows a large mass in the right occipital lobe. A 4.4 × 4.2 × 4.8 cm sized heteroge-neous mass with brain edema was observed in gadolinium enhanced T1- weighted image of axial view (A), in T2-weighted image of axial view (B), and in fluid attenuated T2-weighted sagittal view (C).

Figure 3.

Pathologic findings of metastatic brain tumor. (A) Photomicrograph shows polygonal tumor cells arranged in thick trabe-culae and intervening sinusoid-like vascular spaces (Hematoxylin and eosin staining, ×200). (B) Immunohistochemical staining for hepatocyte specific antigen shows diffuse cytoplasmic positivity in tumor cells (×400).

Figure 4.

Visual field and optical coherence tomography at one month after tumor resection. (A) Humphrey visual field demonstrates slight resolution of left homonymous hemianopia. (B) Optical coherence tomography shows normal peripapillary retinal nerve fiber layer and (C) ganglion cell- inner plexiform layer thickness. RNFL = retinal nerve fiber layer; OD = oculus dexter; OS = oculus sinis-ter; TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; S = superior; N = nasal; I = inferior; T = temporal; GCL = ganglion cell layer; IPL = inner plexiform layer.

Figure 5.

Postoperative brain magnetic resonance imaging shows total removal of enhancing mass in the right occipital lobe in fluid attenuated T2-weighted axial view. Postoperative brain magnetic resonance imaging shows total removal of enhancing mass in the right occipital lobe in fluid attenuated T2-weighted axial view. Marginal enhancement of the resection cavity suggests reactive change in the occipital lobe.

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