TY - JOUR
T1 - Unresectable hepatocellular carcinoma with a solitary metastasis to the mandible
AU - Li, Ryan
AU - Walvekar, Rohan R.
AU - Nalesnik, Michael A.
AU - Gamblin, T. Clark
N1 - Funding Information:
This research was supported by funds from UCSF DRC NIH P30DK063720 and UCSF NORC NIH P30DK098722; an AMC Graduate School PhD Scholarship to J.E.S.; NIH R01AR05439 and NIH R01GM095941, the Burroughs Wellcome Fund and the David & Lucile F. Packard Foundation to J.F.R.; NIH R01DK60540 to C.V.; NIH RO1DK106404 to C.V. and J.F.R.; NIH RO1DA012864 and NIH RO1DA010711 to M.V.Z.; and a New Frontier Research Award through the UCSF Program for Breakthrough Biomedical Research to C.V., J.F.R. and M.V.Z. We thank K. Deisseroth (Stanford University) for providing plasmids.
PY - 2008/4
Y1 - 2008/4
N2 - Hepatocellular carcinoma (HCC) continues to pose a worldwide burden on health resources with an occurrence of 1.4 million cases annually. It represents the fifth most common cancer in men and eighth most common in women worldwide. Eighty per cent of patients have a background cirrhotic liver, most commonly in the United States, resulting from chronic hepatitis C infection, whereas alcoholism also commonly contributes to the development of cirrhosis. Fifty per cent of patients diagnosed with HCC present with metastatic disease. Sites of metastasis commonly include the lungs, vertebral bones, and abdominal lymph nodes. Metastasis to the oral region is very rare. We report a 55-year-old man with metastatic HCC to the mandible. The patient was previously diagnosed with unresectable HCC and had undergone six cycles of chemoembolization therapy. Although the lesion remained stable in size, he did not qualify for liver transplantation because of active alcohol use. He presented to the emergency room for evaluation of recent-onset jaw pain. There was no history of trauma and an oral examination did not reveal any mucosal lesions. Mild swelling and tenderness of the right jaw was noted, and a subsequent CT scan revealed a right-sided mass centered around a fracture of the body of the mandible and surrounded by the masseter muscle. A biopsy of the mass revealed a metastatic hepatocellular carcinoma and a CT scan of the chest, abdomen, and pelvis confirmed it to be a solitary metastasis. The patient underwent surgical resection of a segment of the right mandible and the metastatic tumor. He continues to receive regional chemoembolization and is currently pain-free. Solitary metastasis to the mandible in the setting of HCC is exceedingly rare. Fine needle aspiration biopsy of the lesion with immunohistochemical analysis is useful in characterizing the lesion and identifying the primary site. Radiotherapy has been used to palliate mandibular metastases; however, surgical intervention proved to be very effective in managing this patient's disease.
AB - Hepatocellular carcinoma (HCC) continues to pose a worldwide burden on health resources with an occurrence of 1.4 million cases annually. It represents the fifth most common cancer in men and eighth most common in women worldwide. Eighty per cent of patients have a background cirrhotic liver, most commonly in the United States, resulting from chronic hepatitis C infection, whereas alcoholism also commonly contributes to the development of cirrhosis. Fifty per cent of patients diagnosed with HCC present with metastatic disease. Sites of metastasis commonly include the lungs, vertebral bones, and abdominal lymph nodes. Metastasis to the oral region is very rare. We report a 55-year-old man with metastatic HCC to the mandible. The patient was previously diagnosed with unresectable HCC and had undergone six cycles of chemoembolization therapy. Although the lesion remained stable in size, he did not qualify for liver transplantation because of active alcohol use. He presented to the emergency room for evaluation of recent-onset jaw pain. There was no history of trauma and an oral examination did not reveal any mucosal lesions. Mild swelling and tenderness of the right jaw was noted, and a subsequent CT scan revealed a right-sided mass centered around a fracture of the body of the mandible and surrounded by the masseter muscle. A biopsy of the mass revealed a metastatic hepatocellular carcinoma and a CT scan of the chest, abdomen, and pelvis confirmed it to be a solitary metastasis. The patient underwent surgical resection of a segment of the right mandible and the metastatic tumor. He continues to receive regional chemoembolization and is currently pain-free. Solitary metastasis to the mandible in the setting of HCC is exceedingly rare. Fine needle aspiration biopsy of the lesion with immunohistochemical analysis is useful in characterizing the lesion and identifying the primary site. Radiotherapy has been used to palliate mandibular metastases; however, surgical intervention proved to be very effective in managing this patient's disease.
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M3 - Article
C2 - 18453303
AN - SCOPUS:41749115745
SN - 0003-1348
VL - 74
SP - 346
EP - 349
JO - American Surgeon
JF - American Surgeon
IS - 4
ER -