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

Case report: Condylar metastasis from hepatocellular carcinoma: An uncommon case report and literature review

Background

Patients with hepatocellular carcinoma are often affected by metastases, but condylar metastasis is particularly rare.

Case presentation

A 51-year-old man with a history of hepatocellular carcinoma requested treatment for facial pain. Computed tomography indicated that the condylar bone has been destroyed and fractured. Pathology confirmed condylar metastasis from hepatocellular carcinoma. Complete metastasectomy and condylar reconstruction were performed to preserve his facial appearance. No local recurrence or distant metastasis was found at 8 months of follow-up.

Conclusion

The condyle can be a metastatic site of hepatocellular carcinoma, regardless of its rarity. Long-term comprehensive surveillance and follow-up are needed for patients with hepatocellular carcinoma. The presence of solitary mass does exclude the possibility of metastatic cancer for these patients, and postoperative imaging and pathological diagnosis are important to determine its origin. If patients' physical condition permits, the mass can be completely excised, and the physiological function can be restored and reconstructed.

A Rare Case of Metastatic Hepatocellular Carcinoma to the Hard Palate

Extrahepatic metastasis of hepatocellular carcinoma (HCC) to the head and neck is unusual, especially the oral cavity/maxillofacial region. Metastatic HCC to the hard palate, however, is particularly rare. The most common site of HCC metastasis is the lung, followed by lymph nodes, bone, and adrenal gland. Importantly, oral cavity metastatic HCC may be misdiagnosed as a primary malignancy, such as a salivary gland carcinoma. In this article, we describe a young woman with metastatic HCC to the hard palate that was initially diagnosed as an acinic cell carcinoma.

Metastatic Tumors to the Oral Soft Tissues and Jawbones: A Retrospective Analysis of 40 Cases and Review of the Literature

BACKGROUND

Metastasis to the oral soft tissues and jawbones is rare and frequently associated with wide spread disease and dismal prognosis. Herein, we report the clinicopathologic characteristics of 40 intraoral metastatic neoplasms and perform a comprehensive review of the pertinent literature.

METHODS

Criteria for inclusion included: (a) archived cases from the UMN Oral Pathology laboratory with available tissue blocks and/or H&E-stained preparations diagnosed between 2003 and 2021, (b) proper documentation of the clinico-radiographic characteristics of oral metastasis along with confirmed history of primary malignancy, or (c) microscopic findings consistent with metastatic disease with or without discovery of the primary site.

RESULTS

Intraoral metastases comprised 0.03% of all accessioned cases; 22 (55%) occurred in men and 18 (45%) in women (median age = 66.5; range = 18-94 years). Eighteen cases (45%) involved the gingiva, 16 (40%) the gingiva and jawbones, 5 (12.5%) were exclusively intraosseous, and 1 affected (2.5%) the tongue. The lung was the two most frequent primary site in both men (n = 6, 27.3%) and women (n = 5, 27.7%), followed by the colon (n = 4, 18.2%) and kidney (n = 3, 13.7%) in men, and colon (n = 4, 22.2%) and breast (n = 3, 16.6%) in women. Analysis of 1,084 metastatic cases from the literature (male-to-female ratio = 1.2; mean = 52.3; range = 0.6-90 years) indicated strong preference for the jawbones (69.5%) and significant site-specific predilection of certain primary malignancies.

CONCLUSIONS

Oral and gnathic metastases are rare but demonstrate a clear predilection for the gingiva and mandible. Clinicians should remain cognizant of such lesions since they frequently mimic inflammatory, reactive or benign neoplastic processes and, in certain cases, are the first indication of occult disease.

Metastatic hepatocellular carcinoma to the bone diagnosed by fine needle aspiration in a veteran population

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and it may present initially with extrahepatic spread in 5%-15% cases. It most commonly metastasizes to lungs, lymph nodes and adrenal glands. Skeletal metastases from HCC are uncommon and carry a very poor prognosis.

METHODS

We retrospectively reviewed all fine needle aspiration (FNA) specimens of metastatic HCC at our institution from January 1994 to March 2021 using the SNOMED search computer option. Relevant clinical information was obtained from the review of patient's electronic medical records.

RESULTS

There were 36 FNAs of metastatic HCC over a period of 27 years. Six patients (16.7%) were found to have skeletal metastases. All six patients were males with a median age of 59 years (54-71 years) and their lesions were osteolytic. The most common site of metastases was vertebra (3/50%). Most patients (67%) had bone metastases as an initial presentation, without prior history of HCC. The mean survival after the diagnosis of skeletal metastases was only 8 months.

CONCLUSION

Detection of extrahepatic HCC to bone is important to avoid any unwanted surgical intervention. In our patient population, the most common site of skeletal metastases from HCC was vertebra, therefore in FNAs of vertebral lytic masses, metastatic HCC should be considered. On FNA, extrahepatic metastases of HCC can mimic other poorly differentiated tumors. They behave in an aggressive fashion, resulting in a grim prognosis. Cytological substrates can be used for future molecular testing, if needed.

Prognosis of hepatocellular carcinoma metastasizing to the oral cavity

Background

Oral metastasis by hepatocellular carcinoma (OMHCC) is extremely rare, and the prognosis had been reported quite poor due to simultaneous multiple organ metastases. In this study, we report clinical features and survival of 10 new cases of OMHCC and suggest the criteria for palliative surgery.

Methods

A retrospective clinical study including 10 new cases of oral OMHCC between 2006 and 2016 was performed. Clinical features and survival analysis were examined. The recorded variables were age, sex, site of oral metastases, size of oral tumor (largest diameter), and survival after oral histopathologic diagnosis.

Results

There was male (n=8) predilection of OMHCC. The mean survival time was 16.9 months. Patient age ranged from 40 to 71 years (mean 56.5). Eight mandibular and two maxillary lesions were found. One patient showed simultaneously the maxilla and the oral tongue involvement. The most often encountered symptoms were swelling (80%) followed by pain (60%), numbness (60%), bleeding (10%), and tooth mobility (10%). Four patients underwent operation due to spontaneous bleeding and swelling of the cancer. Overall (from onset of hepatocellular carcinoma) and truncated survival (from onset of OMHCC) were 71.9 and 13.1 months respectively.

Conclusion

The prognosis of OMHCC was quite poor. Oral and jaw bone examination should be included in patients with multiple metastasis of HCC. Palliative surgery might be performed in patients who reported spontaneous bleeding, severe pain, and oral dysphasia due to tumor enlargement.

Radiotherapy for mandibular metastases from hepatocellular carcinoma: a single institutional experience

Purpose

A mandibular metastasis is uncommon in patients with hepatocellular carcinoma (HCC). We report the clinical features of this rare lesion and evaluate the effectiveness of radiotherapy in affected patients.

Materials and Methods

We retrospectively reviewed our institutional medical records for HCC patients who received radiotherapy for bone metastasis, and included cases of mandible metastasis. The clinical features of these cases, and the characteristics and outcomes of the treatments were assessed.

Results

A total of 1,498 patients with a bone metastasis from HCC were treated with radiotherapy between July 1998 and April 2012 at our institution. We identified 9 patients (0.6%) in this cohort that received radiotherapy for a mandibular metastasis. The condyle was the most common location of mandibular metastasis. The median radiation dose was 40 Gy (range, 27.5 to 60 Gy), with a daily dose of 2–3 Gy. All of these 9 patients died during a median follow-up of 9 months (range, 1 to 19 months). Symptom relief was achieved in 7 of 8 patients who completed radiotherapy. Tumor size reduction was observed in 2 of 4 patients who underwent radiologic evaluation after radiotherapy.

conclusions

Metastasis to the mandible from HCC has a poor prognosis. Radiotherapy can be an effective local treatment option for symptomatic relief in these cases.

Metastatic tumors in oral mucosa and jawbones: Unusual primary origins and unusual oral locations

AIM

To perform clinico-pathological characterization of a large series of oral metastases, collected from 3 main medical centers in Israel and compare findings to data on frequency of primary cancer types in the population.

MATERIALS

Pathology archives were searched for cases of metastatic tumors to the oral soft tissues and jawbones, 1990 - 2016. Metastases to the skin of face or to major salivary glands have been excluded. Demographic data and histopathological features were analyzed.

RESULTS

Study population included 60 patients, 35 females and 25 males (ratio of 1.4:1). The age range was 17-87 years, mean 67.7 + 14.36 years. Only 3 (5%) patients were under 40 years, the remaining clustered predominantly in the 60-80 year age group. The mean age of females (59 + 13.84) was significantly lower than that of males (67.44 + 14) (p = 0.03). There was an almost equal distribution between the oral soft tissue and the jawbones (48.3% and 51.7%, respectively). The five most common organs from which metastases were distributed to the oral cavity and jawbones combined were kidney (20%), breast (15%), cutaneous (predominately melanoma, 13%), lung (11.7%) and soft tissue-sarcomas (8.3%). For comparison, Israel National Cancer Registry 2013 reported that the most frequent malignancies were breast (25.8%), colorectal cancer (16.3%), lung (12%) and prostate (10%). Malignant melanoma was 6th (5.4%), kidney malignancy was only 9th in frequency (4.2%). Although the gingiva and jawbones were the most frequent locations, some cases presented in unusual locations, (mandibular vestibule, lower lip, posterior dorsal tongue), without any specific clinical feature to suggest metastasis.

CONCLUSIONS

The most frequent primary origins for oral metastasis do not correspond to the relative frequency of the primary tumors in the population, indicating that metastatic spread is not a random process. Although the majority of metastasis involves the gingiva and jawbones, any other oral mucosal location might be involved. Thus, in adult/older patients, metastasis from a distant site should be included in the differential diagnosis of oral masses at any oral location, whether the existence of a primary tumor is reported or not.

Maxillary metastasis from a hepatocellular carcinoma: Report of an uncommon presentation and literature review

INTRODUCTION

Oral metastases from hepatocellular carcinoma (HCC) are very rare, and predominate in the mandible. We report an exceptional case of maxillary metastasis revealing HCC.

CASE REPORT

A 56-year-old man with a previous medical history of alcohol abuse presented to our department with a 3-week evolving oral mass. Physical examination showed a left maxillary tumor. The biopsy revealed a HCC and a multi-metastatic HCC with portal thrombosis and a pulmonary embolism was discovered following a CT-scan. A state of advanced malnutrition contraindicated sorafenib chemotherapy. Thus, external irradiation was proposed, without success. The patient subsequently died 50 days later.

DISCUSSION

Maxillary HCC metastases are extremely rare. The average age of HCC jaw metastases appearance in patients has been reported to be approximately 57 years, men are more affected than women are, and the mean life expectancy is 12 months following the diagnosis. These patients require palliative treatment. Local recurrences occur very early after possible surgery, and expose the patient to life-threatening bleeding.

A metastasized hepatocellular carcinoma in the capsule of an undescended testis in the right inguinal area: report of a rare case

Background

Hepatocellular Carcinoma (HCC) is the most common primary carcinoma of the liver, which mainly metastasizes through the portal vein system.

Case presentation

Here, we report an extremely rare case in which HCC metastasized to the capsule of an undescended testis in the right inguinal area of the patient. A tumor approximately 8.8 × 7.0 cm in size was found in the patient’s liver during a health check-up. Initially, it was considered a metastatic tumor because the patient was found to have cryptorchidism, which had been left untreated before he presented to our hospital. The patient underwent a radical orchiectomy via inguinal approach, and the resected testis in the right inguinal region was examined via microscopy. The cancer cells were arranged in nests and showed abundant red or clear cytoplasm and marked nuclear atypia. Immunohistochemical staining showed that the tumor cells were positive for CK, CK8/18, AFP, hepatocyte, GCP3, but negative for PLAP, CD10, CD30, CD34, and vimentin.

Conclusion

According to these findings, the tumor in the inguinal region was considered a metastatic HCC arising from the liver, rather than a seminoma that had originated in the undescended testis. We suggest that during the diagnosis of malignancies, metastatic tumors should always be considered in the differential diagnosis even if the original presentation is at rare metastatic sites or concurrent with other disease(s).

Lone Hepatocellular Carcinoma: An Isolated Chest Wall Malignancy

Herein we describe the case of an elderly diabetic gentleman presenting with a two-week history of dyspnea and nonproductive cough, found to have a large left anterolateral chest wall mass. Further characterization through computed tomography (CT) of the chest revealed a soft tissue mass in the left anterior lower hemithorax found to be hepatocellular carcinoma (HCC). The liver, spleen, and pancreas were unremarkable. Diagnostic labs were unremarkable. The patient had no history of hepatitis, alcohol abuse, or illicit substance use. Pathological examination and immunohistochemical staining of the chest mass biopsy were consistent with metastatic hepatocellular carcinoma (HCC). The patient opted to pursue no further medical intervention and expired two weeks later. To the authors' knowledge, this is one of very few descriptions of isolated hepatocellular carcinoma found in the absence of a primary liver lesion and classical risk factors for hepatocarcinogenesis. This case highlights that HCC may present independently of liver lesions seen on imaging in a patient without clear signs or symptoms of liver. HCC should be considered in cases of isolated tumors with unclear primaries as ectopic carcinogenesis and occult primary malignancy are possibilities.

Metastatic solid tumors to the jaw and oral soft tissue: A retrospective clinical analysis of 44 patients from a single institution

PURPOSE

Metastatic solid tumors to the oral cavity are rare, frequently indicative of an end-stage disease process, and associated with poor survival rates. We performed a 20-year retrospective clinical analysis of our institution's cases of solid metastases to the oral cavity, and investigated these patients' clinical outcomes.

MATERIAL AND METHODS

A retrospective study of patients with metastatic solid tumors to the oral cavity over a 20-year period (October 1996 to September 2015) was conducted at Memorial Sloan Kettering Cancer Center. Patients were selected if they had a histopathologically confirmed diagnosis. Demographic, pathologic, and clinical information were reviewed to identify patient outcomes.

RESULTS

A total of 44 patients with metastatic non-melanocytic non-hematopoietic tumor to the oral cavity were identified: 24 males and 20 females (39 adults and 5 children) with a mean age of 54.3 years. In all, 24 cases involved the jaw and 20 cases involved the oral soft tissue. Eight patients (18.2%) had oral cavity metastases as the first indication of an occult malignancy. In adult patients, the common primary sites were the lungs (n = 9, 20%), kidney (n = 7, 16%), breast (n = 5, 11%), and colon (n = 4, 9%); and in pediatric patients the adrenal gland (3/5) was the most common site. Of the adult patients, 33 (84.6%) died of disease. From the time of metastasis diagnosis, patients with jaw metastases had a median and mean survival of 12 months and 27.7 months, respectively. In comparison, patients with oral soft tissue metastases had a median survival time of 5 months, and mean of 8 months. One pediatric patient (20%) died of disease 8 months after metastasis diagnosis.

CONCLUSION

Metastatic solid tumors to the oral cavity can be the first sign of a malignancy. Pediatric patients with oral cavity metastases have a better prognosis compared to adult patients. In this series, adults with oral soft tissue involvement had shorter survival times compared to patients with jaw involvement.