Ann Hepatobiliary Pancreat Surg.  2020 Feb;24(1):68-71. 10.14701/ahbps.2020.24.1.68.

Hepatocellular carcinoma metastasis to the buccal mucosa masquerading as oral cavity malignancy: Case report of a rare entity

  • 1GI and HPB Services, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
  • 2Department of Pathology, Tata Memorial hospital, Mumbai, India.


Hepatocellular carcinoma, a disease of the developing world, is known to present with extrahepatic metastases. Most common site being the lungs, it is not uncommon for metastases to present at unusual sites like the rectum, spleen and the diaphragm, among others. Metastases to the oral cavity is rare, with the most common primaries being lung, breast and the kidney. Metastases of a hepatocellular carcinoma to the oral cavity is a rare entity with extremely limited data in literature. We present one such unique case of oral cavity metastases from a hepatocellular carcinoma who presented to the Division of Head and Neck Oncology services of our hospital with a large oral cavity lesion, on subsequent workup of which, a hepatocellular carcinoma was identified. Awareness of this possibility can aid in accurate diagnosis and early management of a condition associated with an advanced stage at presentation and poorer prognosis.


Hepatocellular carcinoma; Metastasis; Oral cavity; HepPar 1

MeSH Terms

Carcinoma, Hepatocellular*
Mouth Mucosa*
Neoplasm Metastasis*


  • Fig. 1 Clinical photograph of the oral cavity lesion with position and extent.

  • Fig. 2 (A) CECT abdomen & pelvis; coronal, sagittal and axial sections showing the liver primary with diaphragm & chest wall abutment. (B) CECT abdomen & pelvis axial section showing the liver primary with diaphragm & chest wall abutment.

  • Fig. 3 (A) Histopathology photographs of oral cavity metastatic lesion (magnification 200×). (B) Immunohistochemistry with HepPar 1 (oral cavity metastatic lesion) (magnification 200×). (C) IHC with arginase positivity (oral cavity metastatic lesion) (magnification 200×).

  • Fig. 4 (A) Histopathology photograph of liver lesion biopsy on haematoxylin & eosin stain (magnification of 200×). (B) Immunohistochemistry of liver lesion biopsy with Glypican 3 positivity (magnification of 400×).


1. Sawabe M, Nakamura T, Kanno J, Kasuga T. Analysis of morphological factors of hepatocellular carcinoma in 98 autopsy cases with respect to pulmonary metastasis. Acta Pathol Jpn. 1987; 37:1389–1404. PMID: 2825465.
2. Katyal S, Oliver JH 3rd, Peterson MS, Ferris JV, Carr BS, Baron RL. Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000; 216:698–703. PMID: 10966697.
3. Natsuizaka M, Omura T, Akaike T, Kuwata Y, Yamazaki K, Sato T, et al. Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol. 2005; 20:1781–1787. PMID: 16246200.
4. Will TA, Agarwal N, Petruzzelli GJ. Oral cavity metastasis of renal cell carcinoma: a case report. J Med Case Rep. 2008; 2:313. PMID: 18823541.
5. Makos CP, Psomaderis K. A literature review in renal carcinoma metastasis to the oral mucosa and a new report of an epulis-like metastasis. J Oral Maxillofac Surg. 2009; 67:653–660. PMID: 19231796.
6. Hirshberg A, Leibovich P, Buchner A. Metastases to the oral mucosa: analysis of 157 cases. J Oral Pathol Med. 1993; 22:385–390. PMID: 8301602.
7. Heslop IH. Secondary neoplasia of the jaws. Br J Oral Surg. 1964; 2:47–53. PMID: 5212880.
8. Appenzeller J, Weitzner S, Long GW. Hepatocellular carcinoma metastatic to the mandible: report of case and review of literature. J Oral Surg. 1971; 29:668–671. PMID: 4328199.
9. Ramón Ramirez J, Seoane J, Montero J, Esparza Gómez GC, Cerero R. Isolated gingival metastasis from hepatocellular carcinoma mimicking a pyogenic granuloma. J Clin Periodontol. 2003; 30:926–929. PMID: 14710773.
10. Batson OV. The function of the vertebral veins and their role in the spread of metastases. Ann Surg. 1940; 112:138–149. PMID: 17857618.
11. Lund BA, Soule EH, Moertel CG. Hepatocellular carcinoma with metastasis to gingival mucosa: report of case. J Oral Surg. 1970; 28:604–607. PMID: 4317000.
Full Text Links
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: