A Case of Hepatocellular Carcinoma Presenting as a Gingival Mass

Min Jung Kwon; Soo Hyung Ryu; Soo Yeon Jo; Chul Hoon Kwak; Won Jae Yoon; Jeong Seop Moon; Hye Kyung Lee

doi:10.4166/kjg.2016.68.6.321

Journal List > Korean J Gastroenterol > v.68(6) > 1007592

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Kwon, Ryu, Jo, Kwak, Yoon, Moon, and Lee: A Case of Hepatocellular Carcinoma Presenting as a Gingival Mass

Case Report

Korean J Gastroenterol 2016;68(6):321-325.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.6.321

A Case of Hepatocellular Carcinoma Presenting as a Gingival Mass

Min Jung Kwon, Soo Hyung Ryu, Soo Yeon Jo, Chul Hoon Kwak¹, Won Jae Yoon, Jeong Seop Moon, Hye Kyung Lee¹

Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

¹Department of Pathology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

Correspondence to: Soo Hyung Ryu, Department of Internal Medicine, Inje University Seoul Paik Hospital, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea. Tel: +82-2-2270-0012, Fax: +82-2-2279-4021, E-mail: rshdrryu@hanmail.net

Received 8 July 2016 Revised 10 October 2016 Accepted 19 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Oral metastatic tumor, which is uncommon and represents less than 1% of malignant oral neoplasms, usually arises from a primary mucosal or cutaneous cancer located in the head and neck regions. Metastasis of hepatocellular carcinoma (HCC) to the oral cavity, especially to gingiva, is extremely rare. A 50-year-old man, who was a chronic alcoholic and hepatitis B virus carrier, presented with abdominal distension and weight loss for the past 3 months. Three-phased contrast-enhanced abdominal CT revealed numerous conglomerated masses in the liver, suggesting huge HCCs arising in the background of liver cirrhosis with a large amount of ascites. He complained of recurrent profuse bleeding from the left upper gingival mass. A facial CT revealed an oral cavity mass destructing the left maxillary alveolar process and hard palate, which was diagnosed as metastatic HCC by an incisional biopsy. Herein, we report a case of metastatic HCC to the gingiva.

Keywords: Hepatocellular carcinoma, Neoplasm metastasis, Gingiva, Mouth

References

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Fig. 1.

A protruding mass suggesting metastatic hepatocellular carcinoma is noted at the left gingiva.

Fig. 2.

(A) Arterial phase, (B) portal phase, (C) delayed phase. Numerous hepatocellular carcinomas are seen in the entire liver on abdominal CT. These masses show heterogeneous enhancement in arterial phase and typical wash-out pattern in portal and delayed phase.

Fig. 3.

Facial CT presents malignant tumor involving the alveolar process of the left maxilla and lateral aspect of the left side hard palate (arrow).

Fig. 4.

Photomicrograph of oral mass exhibiting severe nuclear anaplasia and pleomorphism, frequent mitotic figures, including atypical tripolar mitotic spindle (arrow) and sheet to trabecular arrangement. H&E stain, ×200.

Fig. 5.

Cellular tumor demonstrates vascular stroma (arrows), with distinct immunohistochemical expression for CD34 (×100).

Fig. 6.

Large anaplastic and pleomorphic tumor cells with bizarre multinucleated giant cells reveal diffuse cytoplasmic immuno-reactivity for low molecular weight cytokeratin (Cam 5.2, ×400).

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