Bile Formation in Hepatocellular Carcinoma Metastatic to the Mandible: A Case Report

OBJECTIVE Hepatocellular Carcinoma (HCC) metastatic to the mandible, including hisopathology, radiologic analysis, treatment recommendations and literature review. STUDY DESIGN: A case report in the setting of the Greater Los Angeles Veterans Administration Tertiary Care Medical Center. METHODS: Prealong with gross, histologic, and radiologic analyses. RESULTS: A 55 year old patient with known multifocal hepatocellular carcinoma, hepatitis B and C and cirrhosis, presented with a painful mandibular mass after Sorafenib treatment. The patient underwent an FNA of the mandibular mass which showed bile canaliculi and bile formation along with immunoperoxidase staining consistent with hepatocellular carcinoma. Hepatocellular carcinoma rarely metastasizes to the mandible with only 50 cases having been reported in the literature. We describe a unique histopathologic representation of hepatocellular carcinoma meta-erature. Due to the vascular nature of this tumor, radiation therapy and embolization have been described to control bleeding, and surgery has been described in at least one case to control severe hemorrhage. CONCLUSION: Hepatocellular carcinoma metastasis to the mandible is a rare entity; however, this entity should be considered in a patient with known HCC and an oral cavity mass. Although uncommon, the classic should make the diagnosis. Recommendations for treatment are based on the vascular nature of this tumor. The patient presented in this case report received the indicated palliative radiation treatment after the diagnosis was made.