Sixteen cases of hepatoma presenting as craniospinal metastasis without obvious hepatic involvement were reviewed. Metastatic spread of hepatoma to the cerebrum was found in one case, to the cranium in six cases, and to the vertebrae in nine cases. All of these cases had midly abnormal liver function when first evaluated. Of those patients with hepatoma, 56% had evidence of hepatomegaly. Alpha fetoprotein was present, at levels greater than 320 ng/ml, in 69%. Ninety four per cent died of the primary liver disease within one year. For any patient who develops craniospinal metastasis of unknown origin in a geographical area where hepatoma is a common disease, hepatoma should be considered in the differential diagnosis.
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