J Korean Assoc Oral Maxillofac Surg.  2021 Jun;47(3):224-228. 10.5125/jkaoms.2021.47.3.224.

Metastatic hepatocellular carcinoma in the maxilla and temporal bone: a rare case report

• Cho J

• KMID: 2517273
• DOI: http://doi.org/10.5125/jkaoms.2021.47.3.224

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-yearold 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.

Keyword

Hepatocellular carcinoma; Metastasis; Maxilla; Temporal bone

Figure

• 

  Fig. 1 Initial dental panoramic X-ray. Haziness in left maxillary sinus and thinning of left zygoma.

• 

  Fig. 2 Facial computed tomography scan (coronal). Enhancing soft tissue opacification in the left maxillary sinus and bony destruction of the lateral wall of the left maxillary sinus and left zygoma (arrow).

• 

  Fig. 3 Facial computed tomography scan (axial). Extensive invasion of the left masseter possible invasion of temporalis and subcutaneous fat of the left cheek and preauricular area (arrow).

• 

  Fig. 4 Fine-needle aspiration biopsy and Immunohistochemical findings. A. Fine needle aspirate smear shows atypical shaped cell clusters (Papanicolau staining, ×200). B. Cell block shows atypical cell clusters. The tumor cells have abundant eosinophilic cytoplasm and prominent nucleolus. Also, sinusoid-like thin blood vessels are noted (arrows); suspicious of liver cell (H&E staining, ×200). C. The tumor cells are stained for Hepar-1 antibody (×200); proof of hepatocyte. D. Thin blood vessels are positive for CD34 (×200); proof of hepatocellular carcinoma.

• 

  Fig. 5 Abdominal dynamic computed tomography scan. Several hepatocellular carcinoma masses in the liver (arrows).

Reference

References

1. Tang A, Hallouch O, Chernyak V, Kamaya A, Sirlin CB. 2018; Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis. Abdom Radiol (NY). 43:13–25. https://doi.org/10.1007/s00261-017-1209-1. DOI: 10.1007/s00261-017-1209-1. PMID: 28647765.

2. Lei Q, Chen H, Zheng H, Deng F, Wang F, Li J, et al. 2019; Zygomatic bone metastasis from hepatocellular carcinoma and the therapeutic efficacy of apatinib: a case report and literature review. Medicine (Baltimore). 98:e14595. https://doi.org/10.1097/MD.0000000000014595. DOI: 10.1097/MD.0000000000014595. PMID: 31045756. PMCID: PMC6504308.

3. Tomanovic N, Krstic A, Brasanac D, Dimitrijevic M, Terzic T, Boricic I. 2013; Zygomatic bone metastasis as an initial presentation of hepatocellular carcinoma. Arch Iran Med. 16:675–8. PMID: 24206412.

4. Shen ML, Kang J, Wen YL, Ying WM, Yi J, Hua CG, et al. 2009; 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. 67:718–37. https://doi.org/10.1016/j.joms.2008.06.032. DOI: 10.1016/j.joms.2008.06.032. PMID: 19304027.

5. Junquera L, Rodríguez-Recio C, Torre A, Sánchez-Mayoral J, Fresno MF. 2004; Hepatocellular carcinoma metastatic to the mandible: a case involving severe hemorrhage. Med Oral. 9:345–9. PMID: 15292875.

6. Misra SR, Shankar YU, Rastogi V, Maragathavalli G. 2015; Metastatic hepatocellular carcinoma in the maxilla and mandible, an extremely rare presentation. Contemp Clin Dent. 6(Suppl 1):S117–21. https://doi.org/10.4103/0976-237X.152966. DOI: 10.4103/0976-237X.152966. PMID: 25821363. PMCID: PMC4374307.

7. van der Waal RI, Buter J, van der Waal I. 2003; Oral metastases: report of 24 cases. Br J Oral Maxillofac Surg. 41:3–6. https://doi.org/10.1016/s0266-4356(02)00301-7. DOI: 10.1016/s0266-4356(02)00301-7. PMID: 12576032.

8. Grandhi MS, Kim AK, Ronnekleiv-Kelly SM, Kamel IR, Ghasebeh MA, Pawlik TM. 2016; Hepatocellular carcinoma: from diagnosis to treatment. Surg Oncol. 25:74–85. https://doi.org/10.1016/j.suronc.2016.03.002. DOI: 10.1016/j.suronc.2016.03.002. PMID: 27312032.

9. Fujihara H, Chikazu D, Saijo H, Suenaga H, Mori Y, Iino M, et al. 2010; Metastasis of hepatocellular carcinoma into the mandible with radiographic findings mimicking a radicular cyst: a case report. J Endod. 36:1593–6. https://doi.org/10.1016/j.joen.2010.05.009. DOI: 10.1016/j.joen.2010.05.009. PMID: 20728734.

10. Choi SJ, Kim YS, Kim NR, Jeong SW, Lee SH, Jeong JS, et al. 2002; A case of hepatocellular carcinoma with metastasis to gingival mucosa. Korean J Hepatol. 8:495–9. PMID: 12506256.

11. Kamatani T, Tatemoto Y, Tateishi Y, Yamamoto T. 2008; Isolated metastasis from hepatocellular carcinoma to the mandibular condyle with no evidence of any other metastases: a case report. Br J Oral Maxillofac Surg. 46:499–501. https://doi.org/10.1016/j.bjoms.2008.01.001. DOI: 10.1016/j.bjoms.2008.01.001. PMID: 18272270.

12. Hou Y, Deng W, Deng G, Hu L, Liu C, Xu L. 2019; Gingival metastasis from primary hepatocellular carcinoma: a case report and literature review of 30 cases. BMC Cancer. 19:925. https://doi.org/10.1186/s12885-019-6020-7. DOI: 10.1186/s12885-019-6020-7. PMID: 31521125. PMCID: PMC6744688.

13. Ramón Ramirez J, Seoane J, Montero J, Esparza Gómez GC, Cerero R. 2003; Isolated gingival metastasis from hepatocellular carcinoma mimicking a pyogenic granuloma. J Clin Periodontol. 30:926–9. https://doi.org/10.1034/j.1600-051x.2003.00391.x. DOI: 10.1034/j.1600-051x.2003.00391.x. PMID: 14710773.

14. Chin A, Liang TS, Borislow AJ. 1998; Initial presentation of hepatocellular carcinoma as a mandibular mass: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 86:457–60. https://doi.org/10.1016/s1079-2104(98)90373-0. DOI: 10.1016/s1079-2104(98)90373-0. PMID: 9798231.

15. Huang HH, Chang PH, Fang TJ. 2007; Sinonasal metastatic hepatocellular carcinoma. Am J Otolaryngol. 28:238–41. https://doi.org/10.1016/j.amjoto.2006.08.012. DOI: 10.1016/j.amjoto.2006.08.012. PMID: 17606038.

16. Rim JH, Moon SE, Chang MS, Kim JA. 2003; Metastatic hepatocellular carcinoma of gingiva mimicking pyogenic granuloma. J Am Acad Dermatol. 49:342–3. https://doi.org/10.1067/s0190-9622(03)00416-x. DOI: 10.1067/s0190-9622(03)00416-x. PMID: 12894096.

17. Yu S, Estess A, Harris W, Dillon J. 2012; A rare occurrence of hepatocellular carcinoma metastasis to the mandible: report of a case and review of the literature. J Oral Maxillofac Surg. 70:1219–23. https://doi.org/10.1016/j.joms.2012.01.011. DOI: 10.1016/j.joms.2012.01.011. PMID: 22365723.

18. Daley TD, Minett CP, Driman DK, Darling MR. 2011; Oral metastatic hepatocellular carcinoma: a changing demographic in Europe and North America. Immunohistochemical advances in the microscopic diagnosis. Oral Oncol. 47:62–7. https://doi.org/10.1016/j.oraloncology.2010.07.007. DOI: 10.1016/j.oraloncology.2010.07.007. PMID: 20729131.

19. Greenstein A, Witherspoon R, Iqbal F, Coleman H. 2013; Hepatocellular carcinoma metastasis to the maxilla: a rare case. Aust Dent J. 58:373–5. https://doi.org/10.1111/adj.12083. DOI: 10.1111/adj.12083. PMID: 23981222.