Metastatic hepatocellular carcinoma in the maxilla and mandible, an extremely rare presentation

Abstract

Malignancy is characterized by anaplasia, invasiveness, and metastasis. Primary oral squamous cell carcinoma is the most prevalent oral malignancy, but secondary malignancy from distant sites have also been reported. Hepatocellular carcinoma (HCC) is a common primary liver malignancy that frequently metastasizes during the course of the disease, but < 1% of cases show oral involvement. Such secondary neoplasms do not have any pathognomonic clinical or radiologic findings, and therefore they pose a diagnostic challenge. Hence, in the differential diagnosis of malignant tumors of the oral cavity, it is essential to consider the occurrence of both primary as well as metastatic tumors despite the low incidence of the latter. A rare case of HCC metastasizing to both the maxilla and mandible is presented, in which the patient succumbed to the disease as a result of the delay in diagnosis.

A Case of Oral Metastasis From Hepatocellular Carcinoma Displayed on 18F-FDG PET/CT Imaging

“…The metastases to the oral cavity from the lungs, breast, kidney, rectosigmoid colon, liver, and bone are sporadically reported. [1][2][3][4][5][6][7][8][9] Hepatocellular carcinoma is the most common primary liver malignancy, frequently with abdominal lymph nodes, adrenal gland, lungs, and bones metastases during the course of disease. 10,11 In contrast, the oral cavity is a very unusual site of metastasis from HCC.…”

A Rare Case Of Maxillary Hepatocellular Carcinoma Metastasis Mimicking Pyogenic Granuloma In A Geriatric Patient

“…Metastasis from an HCC to the oral region is uncommon and the mechanisms of dissemination are not fully understood. However, the current understanding is that metastatic spread to the jaws from an HCC is considered to be mainly via the hematogenous route with accompanying lung metastasis (8) and, the mandible is the most frequently affected site in the maxillofacial region (1). Regarding sex and region of invasion, the present case is an extremely uncommon presentation of HCC metastasis.…”

“…HCC, which occurs mainly in male patients, is the most common liver cancer, and is usually associated with alcoholism, and hepatitis B and C infections (1). Metastasis from an HCC to the oral region is uncommon and the mechanisms of dissemination are not fully understood.…”

“…Metastatic tumours of the oral region are uncommon and account for only 1-4% of all oral malignancies (1). Oral metastases can occur in the jaw bones and, more rarely, in the oral soft tissues.…”

Prevalence of dental caries in patients with type II diabetes mellitus

“…The organic acid formed in the dental plaque is believed to be a predisposing factor for caries, but this is not completely acceptable because it is a complex combined effect of low pH, calcium, luoride and phosphate that results in the dissolution of minerals in the teeth. (Misra, 2015;Muthukrishnan and Kumar, 2017) The continuous increase of luoride levels at low concentration in plaque luid and saliva is important for caries control (Hicks and Flaitz, 2000;Rohini and Kumar, 2017). Poor sugar level control of diabetes has been associated with mouthdryness due to salivary dysfunction, which predisposes to dental caries.…”