Unusual Presentation of Hepatocellular Carcinoma and Rare Metastasis to the Masticatory Space

Abstract

An incidental liver mass was discovered in a 65-year-old male during a routine ultrasound (US) check-up of his hiatal hernia. The mass, which showed no malignant characteristics, was interpreted as a focal nodular hyperplasia (FNH). Due to normal blood tests and tumor marker levels, as well as the patient's asymptomatic presentation, only regular monitoring was performed. At a check-up 18 months later, CT examination indicated hepatocellular carcinoma (HCC). Surgery was no longer possible due to diffuse liver involvement. Transarterial chemoembolization (TACE) and chemotherapy were started. A possible metastasis to the right adrenal gland was detected. The patient started to experience headaches, vertigo, paresthesia, and pain of the right jaw. A CT scan of the head showed a mass in the right masticatory space. A CT-guided biopsy confirmed a HCC metastasis.