Hepatocellular carcinoma metastatic to the oral cavity including the maxilla and the mandible: report of two cases and review of the literature

Case report and literature analysis: solitary HCC- recurrence in the right maxillary sinus after curative resection

Background

The primary treatment for eligible patients with hepatocellular carcinoma (HCC) is curative liver resection, offering a 5-year overall survival (OS) of 60%-80%. Despite this, the recurrence rate within five years post-resection remains notably high, ranging from 40% to 50%. Instances of recurrence in the maxillary sinus following liver resection are exceedingly uncommon. This report details a unique case of solitary maxillary sinus recurrence after the curative resection of HCC, which underwent maxillary tumor resection, along with a comprehensive review of pertinent literature. No similar cases have been documented previously.

Case presentation

In 2014, an 85-year-old male patient was diagnosed with HCC and subsequently underwent left hepatectomy. Following the resection, the patient underwent a 9-year follow-up period without any evidence of intra or extrahepatic recurrence. In 2023, a computed tomography (CT) scan revealed a 1.4 cm by 1.1 cm mass in the maxillary sinus, without discernible invasion of the alveolar sinus, nasal cavity, orbital cavity, or infratemporal space. We proceeded with the resection of the maxillary sinus mass. Patho-histochemical analysis indicated that the tumor cells in the maxillary sinus were metastatic HCC cells. As of now, the patient remains in good condition with no signs of tumor recurrence.

Conclusion

For patients presenting with solitary maxillary sinus metastasis, optimal liver function, and a favorable performance score, tumor resection may be the preferred treatment option. However, given the rarity of such cases, larger prospective trials are essential to determine an optimal treatment strategy that offers therapeutic benefits.

Metastatic hepatocellular carcinoma in the maxilla and mandible, an extremely rare presentation

Malignancy is characterized by anaplasia, invasiveness, and metastasis. Primary oral squamous cell carcinoma is the most prevalent oral malignancy, but secondary malignancy from distant sites have also been reported. Hepatocellular carcinoma (HCC) is a common primary liver malignancy that frequently metastasizes during the course of the disease, but < 1% of cases show oral involvement. Such secondary neoplasms do not have any pathognomonic clinical or radiologic findings, and therefore they pose a diagnostic challenge. Hence, in the differential diagnosis of malignant tumors of the oral cavity, it is essential to consider the occurrence of both primary as well as metastatic tumors despite the low incidence of the latter. A rare case of HCC metastasizing to both the maxilla and mandible is presented, in which the patient succumbed to the disease as a result of the delay in diagnosis.

Metastasis to the jaws as a first manifestation of hepatocellular carcinoma: report of a case and analysis of 41 cases

INTRODUCTION

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Local metastasis is common but metastasis to the jaw is rare with 40 reported cases in the English language literature.

REPORT OF CASE

We describe a case of a 54-year-old man who, for the past two months, had noticed a rapidly growing facial mass in the posterior mandibular area. The patient was known to be a hepatitis C virus carrier and suffered from liver cirrhosis but the presence of HCC was unknown.

METHODS AND RESULTS

The English language literature was searched for documented cases of HCC metastasis to the jaw, applicable data was evaluated. The literature analysis revealed 41 reported cases (including the present case). In most cases (81%) the jaw lesion was the only known metastasis at the time of HCC diagnosis. Clinical presentation occurred up to 2 years before discovery of the jaw metastasis. Patients with HCC jaw metastasis have a poor survival rate with an average of 6.1 months between diagnosis and death.

CONCLUSIONS

This study shows that an isolated jaw mass may be the initial presentation of HCC and therefore must be considered in the differential diagnosis, especially in the presence of known liver cirrhosis or chronic viral hepatitis.

Metastatic hepatocellular carcinoma of the maxillary sinus: a rare autopsy case without lung metastasis and a review

A rare case of metastatic hepatocellular carcinoma (HCC) of the maxillary sinus in a 67-year-old man is reported along with the findings at autopsy. A fine needle aspiration biopsy specimen revealed a characteristic tumour structure resembling primary HCC. At autopsy, metastatic lesions were recognized in the bilateral adrenals, spleen, sternum, vertebrae and lymph node at the lesser curvature of the stomach, but not in the lung, suggesting that the HCC had metastasized to the maxillary sinus via the plexus venous vertebralis and/or the azygos vein, or lymph duct. In our reviewed 29 cases of metastatic HCC in the oro-maxillofacial region, most patients were men in the 50- to 70-year age range. At least 11 cases did not have lung metastasis, and in 18, metastasis to the oro-maxillofacial region was the first sign of HCC. One should be aware of the possibility to encounter the oral lesion as first sign of metastatic HCC.

Hepatocellular carcinoma metastatic to the oral mucosa: report of a case with multiple gingival localizations

BACKGROUND

Metastases to the oral mucosa are rare, representing less than 1% of the tumors at this site. Most of these metastatic neoplasms originate in the lungs, kidneys, and liver.

METHODS

The clinicopathologic features of an occult hepatocellular carcinoma, metastatic to the oral mucosa, are reported. The patient, a 70-year-old male, complained of 3 distinct polypoid, reddish lesions of the antero-inferior alveolar crest and both the right and left postero-superior attached gingiva, without bone involvement. The lesions were excised, with the clinical diagnosis of multiple vascular tumors, formalin-fixed, paraffin-embedded, cut and stained with hematoxylin and eosin. Consecutive sections were immunostained for alpha-1-antichymotrypsin, CEA, cytokeratins, EMA, hepatocyte antigen, PSA, S-100 protein, and thyroglobulin, using the alkaline phosphatase/anti-alkaline phosphatase technique.

RESULTS

The morphologic features of the lesions were consistent with the diagnosis of carcinoma with trabecular and glandular patterns and bile secretion; furthermore, immunohistochemical reactivity for alpha-1-antichymotrypsin, cytokeratins, CEA, EMA, and hepatocyte antigen was demonstrated and the hepatic origin of the tumor was postulated. Ultrasonography demonstrated a liver mass, which was biopsied and treated by chemoembolization. While no further complications occurred in the oral mucosa, the patient died 8 months after the diagnosis for widespread diffusion of the tumor to the lungs and brain.

CONCLUSIONS

This case emphasizes the need to include metastatic tumors in the differential diagnosis of atypical neoplasms of the oral mucosa and to evaluate the opportunity of surgical treatment in order to preserve the functions of the mouth, even if the prognosis of the primary tumors remains unfavorable.

Initial presentation of hepatocellular carcinoma as a mandibular mass: case report and review of the literature

Hepatocellular carcinoma metastatic to the oral cavity is a rare phenomenon. From 1957 to date, 51 case have been documented in the English literature. In this report we describe a case of metastatic hepatocellular carcinoma manifesting itself as unilateral mandibular paresthesia before the discovery of the primary tumor. In addition, we review the literature related to metastatic hepatocellular carcinoma and the pathways of metastasis.

Mandibular pain as the leading clinical symptom for metastatic disease: nine cases and review of the literature

BACKGROUND

Metastases to the jaws are a rare phenomenon. Nevertheless, the appearance of non-specific symptoms such as toothache can signal the onset of neoplastic disease in some patients.

PATIENTS

In this article, we present details of a 74-year-old patient with a history of breast cancer to illustrate this point. Retrospectively, covering a time span of one year, we could identify nine patients (1.2%) with metastatic disease to the mandible out of a total of 763 patients referred to our Maxillofacial Surgery department with non-specific jaw pain.

RESULTS

Four patients were subsequently diagnosed as having breast cancer, two had lung cancer, one prostate cancer, one renal cell carcinoma and one adenocarcinoma of unknown primary site. Only three of these patients had documented tumor spread to bones before the onset of jaw pain. In the other patients, the dental symptoms were either the first sign of a generalized neoplastic disease, or indicated relapse of disease after long term disease free interval. However, further work up disclosed generalized tumor spread with additional organ- or bone-lesions in all patients, and the median survival was only six months (range 3.5(-)+22) from diagnosis.

CONCLUSION

Pain of uncertain origin in the jaws should alert clinicians to the potential of metastatic disease in patients with a history of cancer and a bone scintigraphy should be done to rule out metastatic involvement. Although metastatic lesions in this area usually herald generalized neoplastic spread according to our experience, prompt diagnosis nevertheless can lead to useful palliation and an enhanced quality of life.

Mandibular metastatic hepatocellular carcinoma: a case involving severe postbiopsy hemorrhage

PURPOSE

To highlight the hemorrhagic character of metastatic hepatocellular carcinoma.

PATIENT AND METHOD

A case report of a patient with mandibular metastatic hepatocellular carcinoma, who had severe postbiopsy hemorrhagic episodes, and literature review is presented.

CONCLUSIONS

Mandibular metastatic hepatocellular carcinoma is a hemorrhagic tumor because of its hypervascular nature. Any rapidly enlarging swelling with ill-defined mandibular destruction suggestive of malignancy should be considered for metastatic hepatocellular carcinoma. Only a needle biopsy should be attempted in view of the hemorrhagic nature of the tumor. Palliative radiotherapy can be useful for the control of local expansile symptoms of the tumor and because of its possible role in the prevention of hemorrhage.

Metastatic tumors to the jawbones: analysis of 390 cases

A review of the English language literature revealed 390 well-documented cases of metastatic lesions to the jawbones. Most metastatic lesions were diagnosed in patients in their fifth to seventh decade. The primary site differed between the genders: for women, it was the breast followed by the adrenal, colo-rectum, female genital organs and thyroid; for men, it was the lung, followed by the prostate, kidney, bone and adrenal. The most common location of the metastatic tumors was the mandible, with the molar area the most frequent site involved. In about 30% of cases the oral lesion was the first sign of the malignant disease. The present data are compared with those of metastatic tumors to the oral mucosa and a view on the possible pathogenesis is presented.

Neoplasms metastatic to the mouth, jaws and surrounding tissues

5% of all malignancies involve the oral cavity. One percent of these malignancies are secondary to neoplasms that are usually found below the level of the clavicles. As it is widely accepted that the jaws do not contain a lymphatic system, it is believed that metastases there occur via the blood stream, a fact that is supported by the occurrence of metastatic foci in areas where spongiosa and slowing of the circulation favour the entrapment of metastatic emboli. This however does not explain why most of the metastases occur in the lower jaw (and in particular in the premolar-molar area) and not in the maxilla, where the spongiosa is more abundant. Batson's plexus has also been mentioned as a possible route of metastasis to the head and neck, thus explaining why, in some cases of metastases, the lungs are not involved, as the blood has not been filtered through the pulmonary bed before reaching the head and neck. In our review of the literature we found 422 metastatic lesions in the mouth, jaws and the surrounding tissues in 365 patients equally divided between men and women. 56.5% of the cases were above the age of 50. In 228 cases there were other metastases as well, whereas in 114 cases the only metastasis found was the one under study. In 22% of the cases, the metastatic focus in our area was the first indication of the existence of an undiagnosed primary malignant tumour somewhere else.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatocellular carcinoma presenting as an oral cavity lesion

A primary hepatocellular carcinoma associated with underlying hemochromatosis appeared as a metastatic mandibular lesion. A swelling of the retromolar area and mandibular paresthesia were the presenting complaints. Hepatocellular carcinoma rarely metastasizes to the orofacial area. To our knowledge, only 18 cases have been reported. The clinical, radiographic, and histologic features of an additional case of hepatocellular carcinoma metastatic to the left posterior alveolar ridge is reported, and the literature is reviewed.