We report a 74-year-old woman who presented with an orbital apex syndrome and pulsatile proptosis. CT showed a right orbital mass that destroyed the orbital sphenoid bone and extended intracranially. Biopsy revealed metastatic hepatocellular carcinoma (HCC), and subsequent investigations demonstrated a high level of serum-fetoprotein and a huge liver mass. The patient died shortly after the biopsy. Rarely reported in the English literature, metastatic HCC is common in Asia, perhaps because of a racial predisposition together with a relatively high prevalence of alcoholic cirrhosis, chronic hepatitis B and C, and exposure to aflatoxins.
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