A Case of Hepatocellular Carcinoma Presenting as a Gingival Mass

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. (Korean J Gastroenterol 2016;68:321-325)

Gingival metastasis from primary hepatocellular carcinoma: a case report and literature review of 30 cases

“…Metastasis of HCC to the gingiva was believed to be extremely uncommon. However, the rarity of gingival metastasis may be overestimated; some cases published in either English [3, 17–33] or non-English [21, 31] journals were not covered by the major literature databases. Some cases may not be reported at all due to potential misdiagnosis.…”

“…Some cases may not be reported at all due to potential misdiagnosis. Some cases first manifested as only gingival lesions [21, 24, 25, 27, 28, 33] or mimicked benign gingival disease [14, 22], both of which would lead to misdiagnosis, especially in the absence of a biopsy and pathological examination.…”

“…The possible pathophysiological mechanism of HCC metastasis to the gingiva remains to be elucidated. The hematogenous route by invasion of the hepatic arterial or portal venous branches is believed to be the preferred mode for oral metastasis [36–38], although, in some cases, metastatic pulmonary tumors are absent [1, 7, 9–11, 13–15, 19, 20, 22, 23, 28, 32, 33]. Among those cases, the valveless vertebral venous plexus (Batson’s plexus) has been proposed as a mechanism for bypassing filtration through the pulmonary, inferior caval and portal venous circulations [39, 40].…”

“…To the best of our knowledge, no more than 12 cases of gingival metastasis from HCC have been included in major literature sources, such as PubMed and Web of Science [4–16]. Nevertheless, these resources have not covered some of the relevant cases published in either English or non-English journals [3, 17–33]. In this manuscript, we reported a male patient aged 87 with gingival metastasis from HCC.…”

A Rare Case of Metastatic Hepatocellular Carcinoma to the Hard Palate

“…To the best of our knowledge, only one metastatic HCC to the hard palate has been reported in the literature. 11 The previously reported metastatic HCC to the hard palate case was a 50-year-old man with chronic alcoholic and hepatitis B with cirrhosis. The metastatic tumor also involved the left maxillary alveolar process, and the patient passed away 1 week after the diagnosis due to hepatic and renal failure.…”