Korean J Gastroenterol.  2016 Dec;68(6):321-325. 10.4166/kjg.2016.68.6.321.

A Case of Hepatocellular Carcinoma Presenting as a Gingival Mass

• Kwon MJ
• Ryu SH
• Jo SY
• Kwak CH
• Yoon WJ
• Moon JS
• Lee HK

• KMID: 2383463
• DOI: http://doi.org/10.4166/kjg.2016.68.6.321

Abstract

Oral metastatic tumor, which is uncommon and represents less than 1% of malignant oral neoplasms, usually arises from a primary mucosal or cutaneous cancer located in the head and neck regions. Metastasis of hepatocellular carcinoma (HCC) to the oral cavity, especially to gingiva, is extremely rare. A 50-year-old man, who was a chronic alcoholic and hepatitis B virus carrier, presented with abdominal distension and weight loss for the past 3 months. Three-phased contrast-enhanced abdominal CT revealed numerous conglomerated masses in the liver, suggesting huge HCCs arising in the background of liver cirrhosis with a large amount of ascites. He complained of recurrent profuse bleeding from the left upper gingival mass. A facial CT revealed an oral cavity mass destructing the left maxillary alveolar process and hard palate, which was diagnosed as metastatic HCC by an incisional biopsy. Herein, we report a case of metastatic HCC to the gingiva.

Keyword

Hepatocellular carcinoma; Neoplasm metastasis; Gingiva; Mouth

MeSH Terms

Alcoholics
Alveolar Process
Ascites
Biopsy
Carcinoma, Hepatocellular*
Gingiva
Head
Hemorrhage
Hepatitis B virus
Humans
Liver
Liver Cirrhosis
Middle Aged
Mouth
Mouth Neoplasms
Neck
Neoplasm Metastasis
Palate, Hard
Tomography, X-Ray Computed
Weight Loss

Figure

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  Fig. 1. A protruding mass suggesting metastatic hepatocellular carcinoma is noted at the left gingiva.

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  Fig. 2. (A) Arterial phase, (B) portal phase, (C) delayed phase. Numerous hepatocellular carcinomas are seen in the entire liver on abdominal CT. These masses show heterogeneous enhancement in arterial phase and typical wash-out pattern in portal and delayed phase.

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  Fig. 3. Facial CT presents malignant tumor involving the alveolar process of the left maxilla and lateral aspect of the left side hard palate (arrow).

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  Fig. 4. Photomicrograph of oral mass exhibiting severe nuclear anaplasia and pleomorphism, frequent mitotic figures, including atypical tripolar mitotic spindle (arrow) and sheet to trabecular arrangement. H&E stain, ×200.

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  Fig. 5. Cellular tumor demonstrates vascular stroma (arrows), with distinct immunohistochemical expression for CD34 (×100).

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  Fig. 6. Large anaplastic and pleomorphic tumor cells with bizarre multinucleated giant cells reveal diffuse cytoplasmic immuno-reactivity for low molecular weight cytokeratin (Cam 5.2, ×400).

Reference

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