Hepatocellular carcinoma metastasis to the gingival soft tissues: A case report and review of the literature

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.

Keywords: gingival; hepatocellular carcinoma; immunohistochemistry; metastasis.

Figure 1.

Microscopic analysis of the gingival soft tissue tumor cells, revealing tumor cells (A) located in the submucosa (magnification, x100), and (B and C) arranged in trabecular, solid growth patterns (magnification, x200). (B) Inflammatory exudates and necrosis were identified on the surface of the mucosa, and (C) numerous tumor cells were arranged in pseudoglandular patterns. (D) The tumor cells were almost uniform in size and the nuclei were prominent (magnification, x200; hematoxylin and eosin staining).

Figure 2.

Immunohistochemical analysis of the gingival soft tissue tumor cells, revealing negative (A) high molecular weight cytokeratin and (B) p63 (magnification, x100), and positive for (C) glypican 3 and (D) hepatocytes (magnification, x200).