2490 A Rare Initial Presentation of HCC

Abstract

INTRODUCTION: Metastasis accounts for approximately 1-4% of all oral malignancies. Other cancers that spread to the mandible include lung, breast, kidney and colon. Hepatocellular carcinoma (HCC) has the fifth highest prevalence worldwide but only 68 cases of mandibular metastasis have been documented between 1957 to 2011. The following is a rare case of HCC presenting as mandibular metastasis. CASE DESCRIPTION/METHODS: The patient is a 73-year old Hispanic male with history of diabetes mellitus type 2, hypothyroidism, mild dementia, and alcoholic liver cirrhosis who presented with a one-month history of progressively enlarging painless mass in the left mandible, anemia and a 9-month history of weight loss. Additionally, one month ago the patient suffered a traumatic fall. Physical exam was significant for the presence of a malodorous, bleeding oral mass and a left humeral fracture. Initial CT imaging revealed a well-defined, expansile lytic mass in the left mandible, with an additional mass in the right mandible and the right paraspinal area of C1. Additional imaging revealed multiple hepatic lesions, a left humeral mass associated with the fracture and multiple lytic spinal lesions. Alfa-fetoprotein was significantly elevated. Biopsy of the mandibular mass revealed HCC with positive staining of hep par 1 glypican-3 and focal villin. After discussion, the patient and family decided to pursue conservative management with hospice care. DISCUSSION: Mandibular metastasis has been reported during the late stages of HCC, however mandibular involvement as an initial presenting sign is extremely uncommon. Therefore primary liver malignancy should always be considered in patients who present with mandibular tumors with HCC risk factors.