Adenoid cystic carcinoma of maxillary sinus with metastatic hepatocellular carcinoma

Abstract

A case of collision tumor in the left maxillary sinus composed of adenoid cystic carcinoma (ACC) and metastatic hepatocellular carcinoma (HCC) is reported. Radiographic examination revealed masses in the liver and bilateral lung metastases. Histologically, proliferation of tumor cells with resemblance to HCC was observed, in addition to the ACC. For this reason, differential diagnosis between a second primary tumor and metastasis was made. The metastatic lesion immunohistochemically showed positivity for hepatocyte antigen (OCH1E5) and protein induced by vitamin K absence or antagonist II (PIVKA-II), sustaining the HCC diagnosis. Primary ACC and metastatic HCC in the maxillary sinus are rare, and this may therefore be the first case of maxillary sinus tumor with both these elements.

Two primary tumours metastasizing to the liver in a collision phenomenon

“…Whereas collision tumour is a definition usually given to primary tumours, the ‘collision phenomenon’ involves the presence of a secondary deposit in the tumoural mass. It refers to the combination of a primary with a metastasis from another distant tumour 7–9 or from two metastases originating from primaries metastasizing in the same site 10 . Cases of collision phenomenon are rarer than collision tumours and have been reported in organs different from the liver such as the thyroid (thyroid primary + metastatic liposarcoma), lymph nodes (lymphoma primary + metastatic breast) and maxillary sinus (maxillary sinus primary + metastatic HCC) 7–9 or two metastasis harbouring in a mesorectal lymph node draining cells from a rectal and a prostatic adenocarcinoma 10 .…”

“…It refers to the combination of a primary with a metastasis from another distant tumour [7][8][9] or from two metastases originating from primaries metastasizing in the same site. 10 Cases of collision phenomenon are rarer than collision tumours and have been reported in organs different from the liver such as the thyroid (thyroid primary + metastatic liposarcoma), lymph nodes (lymphoma primary + metastatic breast) and maxillary sinus (maxillary sinus primary + metastatic HCC) [7][8][9] or two metastasis harbouring in a mesorectal lymph node draining cells from a rectal and a prostatic adenocarcinoma. 10 To date, the existence collision phenomena composed of liver metastases with cells originating from two different primary cancers has still not been presented.…”