• Michael J Yang, Knarik Arkun, and Carl B Heilman.
• Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA. Electronic address: MYang1@TuftsMedicalCenter.org.
• World Neurosurg. 2019 Aug 1; 128: 324-327.

BackgroundIntracranial metastasis is a common complication of systemic malignancy. A rare subset of intracranial masses constitutes tumor-to-tumor metastasis, in which an extracranial neoplasm hematogenously spreads to an existing intracranial lesion.Case DescriptionHere we present the unique case of a 59-year-old man with known hepatocellular carcinoma who presented with acute headaches, double vision, vertigo, and gait instability in the context of 2 years of right-sided hearing loss. Head imaging showed a heterogeneous right cerebellopontine angle mass extending into the porus acousticus with adjacent cerebellar edema. Histopathologic analysis after resection found coexisting hepatocellular carcinoma within a vestibular schwannoma.ConclusionsTumor-to-tumor metastasis is an important consideration in the diagnostic work-up and treatment of patients with known systemic malignancy who present with a new intracranial lesion. This pathologic entity could be missed if this patient were treated with single-fraction radiosurgery such as Gamma Knife.Copyright © 2019 Elsevier Inc. All rights reserved.

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