1. Undiagnosed primary Hepatocellular carcinoma
presenting as a metastatic tumour in the mandible
P.R Jayasooriya, N.S Wadusinghearachchi & *R.M.P Ratnayake
Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya &
*Teaching hospital, Kandy, Sri Lanka
HB-12
Introduction
Metastatic tumours account for <1% of all malignancies diagnosed in the oral cavity. Metastatic Hepatocellular Carcinoma (HCC) in the oral cavity is extremely rare, with only, seventy five cases reported in the literature to-date.
Clinical history
A 72 year old female presented with paraesthesia of the lower lip and a radiolucent swelling with irregular margins at the angle of the mandible. Presence of rib radiolucencies in a chest x-ray taken subsequently resulted in favouring a metastatic tumour as the most likely possibility.
Subsequent imaging studies demonstrated primary multifocal HCC of the liver with right portal vein thrombosis.
Discussion
HCC is the most common malignant tumour of the liver. Approximately, 25% of HCC may develop, extra-hepatic metastasis with the preferred sites being lung, regional lymph nodes and bones, mainly ribs and long bones. However, mandibular metastasis of HCC is a rare occurrence.
Literature review based summary of demographic profile of the 75 cases of metastatic HCC of the oral cavity
Clinical presentation of the lesion
Radiological presentation
Feature
Distribution
Age distribution
Mean age at diagnosis
Age range
65±13yrs
16-88yrs
Sex distribution
Males
Females
Unknown 61 07
Site distribution
Mandible
Maxilla
Soft tissues 35 04 21 15
Microscopic Pathology
The H&E stained section showed, large lobules of tumour cells containing eosinophilic granular cytoplasm, with a syncytial arrangement reminiscent of the organization seen in the liver. Bile van Geison stain revealed the presence of bile pigments. Hep-par positivity was useful to confirm the diagnosis of metastatic HCC.
Conclusion: The present case is unusual as the metastatic tumour lead to the diagnosis of primary HCC and therefore, it is essential for Oral Pathologists to be aware of this uncommon presentation to render the correct diagnosis.
Note-green coloured bile
pigments
H&E view of metastatic HCC