Abstract
Metastases to the gingival soft tissues are rare in hepatocellular carcinoma (HCC). To the best of our knowledge, only 13 cases have been reported in English literature to date. The present study described the case of a 43-year-old Chinese man who was admitted to Tangdu Hospital (Xi'an, China) due to the presence of a gingival tumor that was initially diagnosed as granulation tissue by a dental surgeon. Examination of the patient's medical history revealed that a solid mass, measuring 1.5 cm in diameter, was identified in the right lobe of the liver 2 years prior to presentation at the current hospital; however, no biopsy was performed. Thus, the tumor was resected and histological examination resulted in an initial diagnosis of atypical squamous cell carcinoma. However, the histopathological characteristics, immunohistochemical features and serum α-fetoprotein expression levels supported a diagnosis of metastatic HCC. In conclusion, the present case study highlights the difficulties in diagnosing metastatic HCC without a history of primary HCC, and the importance of excluding a diagnosis of metastatic tumor when a lesion is identified in the gingival. Furthermore, it was determined that a final diagnosis of gingival metastasis of HCC predominantly depends on pathological characteristics and immunohistochemical features.
Highlights
Hepatocellular carcinoma (HCC) is the third most common cause of cancer‐associated mortality worldwide
The tumor cells are positive for α‐fetoprotein (AFP), cytokeratin (CK)18, glypican 3 (GPC3) and hepatocyte paraffin 1 (HepPar‐1), and of these, GPC3, AFP and/or HepPar‐1 are relatively specific to the diagnosis of HCC
The patient in the present study had chronic periodontitis before the gingival tumor was observed. From these studies, circulating reactive oxygen species (ROS), which are produced by host inflammatory cells upon stimulation by bacterial pathogens [24], were identified as a fundamental attributable factor to the association between HCC metastasis and chronic periodontitis
Summary
Hepatocellular carcinoma (HCC) is the third most common cause of cancer‐associated mortality worldwide. The current study presented a case of metastatic HCC to the gingival, and investigated its histopathological characteristics and immunohistochemical features. The current study highlighted the importance of obtaining a comprehensive patient history following the diagnosis of a metastatic malignant tumor of the gingival.Written informed consent was obtained from the patient's family. Combining the immunohistochemical analysis results and the patient history, a diagnosis of metastatic HCC was considered. Further immunohistochemical analysis for additional markers was performed to confirm this diagnosis, using rat anti-human monoclonal antibodies, such as GPC3 (MX005), CK18 (MX004), hepatocyte (OCH1E5), AFP, CD56 (56C04), and chromogranin A (LK2H10+PHE5), and a rabbit anti-human polyclonal antibody against synaptophysin. Considering the observed immunohistochemical characteristics and the clinical history of the patient, metastatic HCC was diagnosed, despite the unconfirmed primary HCC. The patient chose to end his own treatment and was lost in follow-up
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call