Sinonasal Metastatic Hepatocellular Carcinoma Initially Presents with Unilateral Vision Loss

Hepatocellular carcinoma (HCC) seldom presents only as acute visual loss without any other abdomen or systemic symptoms. Sinonasal area, besides, is an extremely rare metastatic site for HCC as well. We reported a rare case of a 69-year-old male, presenting initially with of left eye rapid vision loss, and the sinonasal mass lesion was found two months later when he had left epistaxis attacked. The initial magnetic resonance image was reviewed and indicated a mass lesion on lateral wall of left sphenoid sinus with cavernous sinus and left optic apex involved. Metastatic HCC was subsequently confirmed by biopsy with immunohistochemistry stain. The original HCC was subsequently discovered by abdomen echo and elevated α-fetoprotein. He was then referred for chemotherapy. The presenting symptom of sinonasal tract metastasis originated from hepatic malignancy as acute vision loss could be easily missed. Physicians should always take metastatic neoplasms into clinical differential diagnosis of a unilateral sinonasal lesion.