Mandibular Metastasis as the First Manifestation of Hepatocellular Carcinoma: A Case Report

Abstract

Metastatic malignancies of the oral cavity are rare lesions, accounting for only 1–4% of all oral malignancies, and can occur in the jaw bones, the oral soft tissues, or even both. Although hepatocellular carcinoma is the most common primary hepatic tumor, no more than 1% of the cases show oral involvement. When metastatic tumor involves the oral cavity, the most frequent site is the posterior angle of the mandible. Histologically, hence, immunohistochemical markers are used for diagnosis. Glypican-3 and HepPar1 are the markers that can be used to confirm the microscopic diagnosis of HCC. Very rarely, hepatocellular carcinoma (HCC) metastasizes to the oral cavity, and such cases have a poor prognosis due to delay in diagnosis. We present a 74-year-old male with a metastasis of HCC in the left mandibular body as the first manifestation. Histologic examination confirmed metastatic hepatocellular carcinoma in the oral mucosa with immunohistochemical (IHC) markers. A review of pertinent literature was performed. Given the rarity of the disease, treatment principles are based mainly on retrospective series and case reports. We report an exceptionally unusual presentation with few cases (<70) reported in the literature, thus representing a diagnostic challenge.

A Rare Case of Isolated Hepatocellular Carcinoma Metastasis in Left Mandibular Region in a Patient with Hepatitis C Virus Liver Cirrhosis Diagnosed after the Onset of COVID-19 Infection

“…Commonly reported clinical findings in patients with a mandibular metastasis of HCC are those of a diffuse, firm and painless swelling in the temporal region [14], which are consistent with our patient. Additionally, symptoms including difficulty in opening of the mouth, numbness of the surrounding regions as well as toothache are observed [4,9,10,15,16]. Since there have been various reports of initial presentation of a metastatic HCC with a solitary orofacial metastasis [15,16], even more commonly than after an HCC diagnosis is established [9,16,17], we emphasize the need to consider this possibility in patients with known risk factors for HCC (liver cirrhosis, viral hepatitis and others).…”

“…Additionally, symptoms including difficulty in opening of the mouth, numbness of the surrounding regions as well as toothache are observed [4,9,10,15,16]. Since there have been various reports of initial presentation of a metastatic HCC with a solitary orofacial metastasis [15,16], even more commonly than after an HCC diagnosis is established [9,16,17], we emphasize the need to consider this possibility in patients with known risk factors for HCC (liver cirrhosis, viral hepatitis and others). However, metastatic disease represents ~1% of all malignancies of the oral area [4].…”

Early monitoring values of oncogenic signalling molecules for hepatocellular carcinoma

“…For HCC, the discovery of GPC3 as a promising tumor-associated antigen because GPC3 is over-expressed in cancerous tissues and is significantly associated with poor prognostic disease-free survival and overall survival[ 67 , 68 ]. Indeed, clinical and basic studies have demonstrated that GPC3 is a carcino- embryonic proteoglycan anchored to the membrane of HCC cells and is involved in promoting HCC growth and invasion through a variety of signaling cascades; including the Wnt pathway, which plays a well-known role in embryogenesis[ 69 , 70 ]. It was found that the up-regulated expression of GPC3mRNA, gene or protein in the tissues or serum of patients with liver cancer could not only specifically diagnose liver cancer, but also had a bad prognosis with the patients with liver cancer[ 71 ].…”