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Mašulović D, Igić A, Filipović A, Zakošek M, Bulatović D, Mijović K, Micev M, Galun D. A Rare Case of Isolated Hepatocellular Carcinoma Metastasis in Left Mandibular Region in a Patient with Hepatitis C Virus Liver Cirrhosis Diagnosed after the Onset of COVID-19 Infection. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1992. [PMID: 38004041 PMCID: PMC10673151 DOI: 10.3390/medicina59111992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Hepatocellular carcinoma (HCC) most frequently metastasizes in the lungs, abdominal lymph nodes and adrenal glands. Metastatic spread to the head and neck area is extremely rare. In the presented case, an uncommon site of solitary metastatic spread of HCC to the mandible confirmed after the core biopsy of the lesion is reported. There have been only about 80 cases of mandibular HCC metastases described in the literature to date. We contribute our experience to the pool of data. Case presentation: A 65-year-old female with HCV-related liver cirrhosis was diagnosed with an HCC that was successfully treated with liver resection. Subsequently, the patient had developed COVID-19 disease, which was associated with a painless swelling in the left jaw. A neck MDCT scan demonstrated an osteolytic soft-tissue mass in the left mandible, with the characteristics consistent for the metastasis of HCC. In order to confirm the diagnosis, a core biopsy of the mandibular mass was performed. The pathohistological evaluation confirmed the presence of a metastatic HCC in the mandible. No other sites of disease dissemination were identified in extensive MDCT scans. Despite considering various treatments, including symptomatic and palliative, the patient's overall prognosis remained poor. Conclusions: Isolated metastases of HCC to the orofacial region are extremely rare; however, it should be considered in patients with known risk factors for HCC development. Early diagnosis is critical, and clinicians should consider this possibility of HCC spread when assessing patients with orofacial swelling, among those patients with risk factors for HCC. The overall prognosis for such patients remains poor, emphasizing the challenges in managing these cases.
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Affiliation(s)
- Dragan Mašulović
- Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (D.M.); (A.F.); (M.Z.); (D.B.); (K.M.)
- Department of Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia;
| | - Aleksa Igić
- Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (D.M.); (A.F.); (M.Z.); (D.B.); (K.M.)
| | - Aleksandar Filipović
- Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (D.M.); (A.F.); (M.Z.); (D.B.); (K.M.)
- Department of Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia;
| | - Miloš Zakošek
- Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (D.M.); (A.F.); (M.Z.); (D.B.); (K.M.)
| | - Dušan Bulatović
- Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (D.M.); (A.F.); (M.Z.); (D.B.); (K.M.)
| | - Ksenija Mijović
- Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (D.M.); (A.F.); (M.Z.); (D.B.); (K.M.)
| | - Marjan Micev
- Department for Pathology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Dr Subotica No. 8, 11000 Belgrade, Serbia;
| | - Danijel Galun
- Department of Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia;
- HPB Unit, Clinic for Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Cho J. Metastatic hepatocellular carcinoma in the maxilla and temporal bone: a rare case report. J Korean Assoc Oral Maxillofac Surg 2021; 47:224-228. [PMID: 34187963 PMCID: PMC8249191 DOI: 10.5125/jkaoms.2021.47.3.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a common, primary malignant liver disease that usually metastasizes to the lungs, followed by the abdominal lymph nodes and brain. However, extrahepatic metastasis to the maxillofacial area is uncommon and predominates in the mandible, so HCCs in the maxilla or temporal bone from a primary hepatic lesion are extremely rare. We present a case of HCC in the maxilla and temporal bone in a 52-year-old male, which was first suspected to be a squamous cell carcinoma after computed tomography but was confirmed as a metastasis related to his primary HCC after fine-needle aspiration biopsy followed by immunohistochemical analysis.
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Affiliation(s)
- Juyeon Cho
- Department of Dentistry, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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Varghese S, Helliwell T, Coonoor C. Metastatic carcinoma within an intravascular lobular capillary haemangioma, a case report. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hou Y, Deng W, Deng G, Hu L, Liu C, Xu L. Gingival metastasis from primary hepatocellular carcinoma: a case report and literature review of 30 cases. BMC Cancer 2019; 19:925. [PMID: 31521125 PMCID: PMC6744688 DOI: 10.1186/s12885-019-6020-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/06/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gingival metastasis from primary hepatocellular cancer (HCC) is rare, highly malignant, and generally has no distinct symptoms. Not performing a biopsy can lead to misdiagnosis. This article reports an 87-year-old male with gingival metastasis from HCC. To gain a better insight into this disease, we also conducted a literature review of 30 cases and discussed the clinical and pathological characteristics, diagnosis, treatment and prognosis of this unusual form of liver cancer. CASE PRESENTATION An 87-year-old man was hospitalized with a chief complaint of chronic constipation and diffuse lower extremity edema. His past medical history included a three-year hepatitis B infection and a cerebral infarction 17 years prior. Imaging examination detected a massive hepatocellular carcinoma in the right liver lobe and multiple metastases in the lungs. Oral examinations revealed a reddish, cherry-sized exophytic mass on the right upper gum. The mass was tentatively diagnosed as a primary gingival tumor and was ultimately confirmed by biopsy as a metastatic carcinoma originating in the liver. The patient decided, with his guardians, to receive palliative care and not to remove the mass. Unfortunately, the patient accidentally bit the mass open; profuse bleeding ensued and local pressure exerted a poor hemostatic effect. The patient's condition worsened, and he eventually died of multiple organ failure. We also performed a literature review and discussed 30 cases of gingival metastases from HCC. The findings indicated that these lesions affected males more than females, with a ratio of 6:1, and infiltrated the upper gingivae (63.1%) more than the lower gingivae (36.7%). Survival analysis indicated that the overall survival for patients with upper gingival metastasis was worse than for those with lower gingival metastasis, and patients receiving treatments for primary liver cancer or metastatic gingival tumors had better overall or truncated survival times. CONCLUSION Gingival metastasis from primary hepatocellular carcinoma is rare, and its diagnosis has presented challenges to clinicians. To avoid a potential misdiagnosis, a biopsy is mandatory regardless of whether a primary cancer is located. Early diagnosis and treatment for primary liver cancer or metastatic gingival lesions may improve survival expectations.
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Affiliation(s)
- Yating Hou
- Shantou University Medical College, 22 Xinling Road, Shantou, 515040 Guangdong China
- Department of Gastroenterology, Guangdong Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 ZhongshanEr Road, Guangzhou, 510080 Guangdong China
| | - Weiping Deng
- Department of Gastroenterology, Guangdong Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 ZhongshanEr Road, Guangzhou, 510080 Guangdong China
| | - Gang Deng
- Department of Gastroenterology, Guangdong Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 ZhongshanEr Road, Guangzhou, 510080 Guangdong China
| | - Linhui Hu
- Department of Critical Care Medicine, The People’s Hospital of Gaozhou, 89 Xiguan Road, Gaozhou, 525200 Guangdong China
| | - Chao Liu
- Department of Pathology and Laboratory Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080 Guangdong China
| | - Lishu Xu
- Department of Gastroenterology, Guangdong Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 ZhongshanEr Road, Guangzhou, 510080 Guangdong China
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Chen X, Xu L, Chen X, Teng X, Zheng S. Testicular choriocarcinoma metastatic to skin and multiple organs. Two case reports and review of literature. J Cutan Pathol 2010; 37:486-90. [DOI: 10.1111/j.1600-0560.2009.01296.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ocampo-Acosta F, Robledo J, Aldape-Barrios B, Garcia-Vazquez FJ. Clinico-pathologic conference: case 4. Head Neck Pathol 2009; 3:290-4. [PMID: 20596848 PMCID: PMC2811570 DOI: 10.1007/s12105-009-0143-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 10/01/2009] [Indexed: 10/20/2022]
Abstract
A 45 years old male patient presented with an asymptomatic right mandibular mass that extended from the angle to the premolar area. It had been present for 3 months at the time of the initial presentation. Panoramic radiograph revealed an ill-defined unilocular radiolucency. Previous dental treatment included molar extractions and antibiotic therapy. Considerable bleeding was encountered during incisional biopsy.
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Affiliation(s)
- Fabian Ocampo-Acosta
- School of Dentistry, Universidad Autónoma de Baja California, Tijuana, Baja California Mexico
| | - Juliana Robledo
- Diplomate American Academy of Oral and Maxillofacial Pathology, South Texas Oral Pathology, 1122 Austin Hwy, San Antonio, TX 78209 USA
| | - Beatriz Aldape-Barrios
- Oral Pathology Department, School of Dentistry, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
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Shen ML, Kang J, Wen YL, Ying WM, Yi J, Hua CG, Tang XF, Wen YM. Metastatic tumors to the oral and maxillofacial region: a retrospective study of 19 cases in West China and review of the Chinese and English literature. J Oral Maxillofac Surg 2009; 67:718-37. [PMID: 19304027 DOI: 10.1016/j.joms.2008.06.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 02/28/2008] [Accepted: 06/16/2008] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of this article was to obtain an overview of metastatic tumors to the oral and maxillofacial (OMF) region, especially the differences in the constituent ratios of primary cancers between the United States and China. PATIENTS AND METHODS Clinical findings of 19 cases encountered in West China Hospital of Stomatology were summarized and the English and Chinese literature were reviewed and analyzed. The main clinical features of OMF metastases were summarized, with an emphasis on primary cancers' constituents. RESULTS The lung, breast, kidney, liver, and prostate were the top 5 common primary sites of cancer. However, there was a significant difference in the primary cancers' constituents between United States and China (P < .001). The breast, kidney, prostate cancers, and melanoma of skin were more frequent primary cancers in United States than in China, whereas that of the lung, thyroid, liver, esophagus, and the stomach were more common in China than in United States. The proportions of the OMF metastatic lesions originating in the lung, kidney, liver, thyroid, and esophagus in all OMF metastatic tumors were higher than the corresponding primary cancers' prevalent proportions. CONCLUSIONS The frequency of developing OMF metastasis is not always consistent with primary cancers' prevalence, which suggests that different cancers have different potentiality to develop OMF metastasis. Cancers of the kidney, liver, lung, thyroid, and esophagus were more likely to spread to the OMF region. In general screening of primary cancer, it would be helpful to take into account the metastatic potentiality of different cancers and primary cancers' prevalence in different countries in the case of occult primary.
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Affiliation(s)
- Mo-Lun Shen
- Master of Medicine, Department of Head and Neck Oncology, West China College of Stomatology, Sichuan University, Chengdu, China
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Masmoudi A, Ayadi L, Bouassida S, Khabir A, Elloumi Y, Boudaya S, Boudawara T, Turki H, Zahaf A. [Gingival metastasis in breast phyllodes tumor]. Ann Dermatol Venereol 2006; 133:449-51. [PMID: 16760832 DOI: 10.1016/s0151-9638(06)70937-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The metastasis of oral cavity is rare. We report a gingival metastasis in the course of low grade phyllode sarcoma of the breast which is usually little metastatic. CASE-REPORT A 44 year old woman was operated two years ago for a phyllod sarcoma of the breast histologically confirmed. She presented for a mandibular exophytic tumour associated with haemorrhagic, necrotic, ulcerated and bulking gingivitis surrounding at the level of the maxillary and mandibular gingiva. The examination revealed multiple nodular lesions of the trunk and the scalp. The histological examination confirmed the diagnosis of cutaneous and gingival metastasis of the phyllod sarcoma of the breast. The evolution was rapidly fatal. DISCUSSION The gingival metastasis are rare tumours with a bad prognostic. Their diagnosis is based on clinical and histological arguments and must be made different from chronic gingivitis which can be associated.
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Affiliation(s)
- A Masmoudi
- Service de Dermatologie, CHU Hédi Chaker, Sfax, Tunisie.
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Lim SY, Kim SA, Ahn SG, Kim HK, Kim SG, Hwang HK, Kim BO, Lee SH, Kim JD, Yoon JH. Metastatic tumours to the jaws and oral soft tissues: a retrospective analysis of 41 Korean patients. Int J Oral Maxillofac Surg 2006; 35:412-5. [PMID: 16473498 DOI: 10.1016/j.ijom.2005.12.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 07/05/2005] [Accepted: 12/28/2005] [Indexed: 11/22/2022]
Abstract
This article describes a pooled analysis of 41 Korean patients with metastatic oral tumours. The data reviewed are from Korean dental and medical case reports published between 1983 and 2004. The mean age was 55.2 years, and the male-to-female ratio was 1.9:1. There were more metastases in the jawbone than in oral soft tissues. The lung was the most common primary site for jawbone metastases, whereas the liver was for those of oral soft tissues. In contrast to reports in Western literature of the breast being the most common primary site, the liver was the most common primary site, followed by the lung and thyroid. These differences may be caused by a relatively high incidence rate of hepatocellular carcinoma in Korea.
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Affiliation(s)
- S-Y Lim
- Oral Biology Research Institute, BK21 Project, School of Dentistry, Chosun University, Gwangju, South Korea
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Elkhoury J, Cacchillo DA, Tatakis DN, Kalmar JR, Allen CM, Sedghizadeh PP. Undifferentiated Malignant Neoplasm Involving the Interdental Gingiva: A Case Report. J Periodontol 2004; 75:1295-9. [PMID: 15515348 DOI: 10.1902/jop.2004.75.9.1295] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Metastases to the gingiva are uncommon. They can be a diagnostic challenge clinically because of their rarity and tendency to mimic benign lesions. In this report, we present a case of an undifferentiated malignant neoplasm of unknown origin presenting as benign inflammatory gingival lesions and we review the literature on metastases to the gingiva. METHODS A 44-year-old female patient was referred by a local periodontist for evaluation of multiple painless gingival lesions that clinically resembled pyogenic granulomas or periodontal abscesses, but with an uncharacteristic multifocal presentation in the background of good oral hygiene. Her medical history was unremarkable except for recent weight loss. Periapical radiographs were obtained, as well as two incisional biopsies, one placed in formalin for routine histology and immunohistochemistry, the other in phosphate buffered saline for flow cytometry. RESULTS Radiographic findings were non-contributory for hard tissue pathoses. Histopathological findings were consistent with a poorly differentiated malignancy, suggestive of metastatic disease. Immunohistochemical studies and flow cytometry were unsupportive in delineating any tumor differentiation. The patient subsequently developed multiple tumors throughout the body with similar histopathological findings, yet no primary tumor was identified and a definitive diagnosis could not be rendered. She was discharged one month later in poor condition with the principal diagnosis of hemorrhage/ pancytopenia, and a secondary diagnosis of metastatic head and neck cancer. CONCLUSION This case of malignant metastatic tumor of unknown origin presenting as benign gingival lesions illustrates the importance of thorough patient evaluation, which should include a biopsy when necessary for definitive diagnosis.
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Affiliation(s)
- Jad Elkhoury
- Section of Periodontology, The Ohio State University, College of Dentistry, Columbus, OH 43218-2357, USA
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