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55-year-old man presents with headache, nausea, and vomiting. Neuroimaging shows a cerebellar mass causing hydrocephalus. Past medical history includes hepatitis C.
Hepatocellular carcinoma (HCC) is a primary malignant tumour of the liver with hepatocytic differentiation. Chronic viral hepatitis is the leading cause of HCC worldwide and the majority of HCCs arise in cirrhosis. Brain metastasis is extremely rare and associated with poor prognosis. Microscopically, architectural patterns of HCC include trabecular, pseudoglandular / acinar, compact, and spindled (sarcomatoid). Tumour cells resemble hepatocytes: polygonal shape, round vesicular nuclei, and prominent nucleoli. Clear cells may be present, due to accumulation of glycogen, water, or fat. Cytoplasmic inclusions, such as Mallory bodies, may be seen. Arginase-1, Hep Par-1 (see Related Content), and glypican-3 are hepatocellular markers of varying sensitivity and specificity.