Hepatocellular Carcinoma Presenting as a Solitary Skull Metastasis: A Rare Manifestation

Abstract Skull metastasis as the first manifestation of hepatocellular carcinoma (HCC) is exceedingly rare. While brain metastases are the most frequent type of intracranial neoplasm in adults, involvement of the skull by HCC is uncommon and can present a diagnostic challenge, particularly when imaging suggests a benign lesion such as a meningioma. We report the case of a 69-year-old male presenting with a progressively enlarging exophytic mass in the right frontal region, initially presumed to be a meningioma based on computed tomography and magnetic resonance imaging. Surgical resection revealed a highly vascularized lesion with no invasion of the dura mater or brain parenchyma. Histopathological and immunohistochemical analyses confirmed the diagnosis of metastatic HCC. Postoperative imaging revealed a primary hepatic tumor and multifocal disease. This case underscores the importance of considering metastatic HCC in the differential diagnosis of exophytic cranial lesions, even in the absence of a known primary liver tumor. A multidisciplinary approach and histopathological confirmation are essential for accurate diagnosis and management.