Gingival metastasis from primary hepatocellular carcinoma: a case report and literature review of 30 cases.

Publisher: BioMed Central Country of Publication: England NLM ID: 100967800 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2407 (Electronic) Linking ISSN: 14712407 NLM ISO Abbreviation: BMC Cancer Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Carcinoma, Hepatocellular/*pathology ; Gingival Neoplasms/*diagnosis ; Gingival Neoplasms/*secondary ; Liver Neoplasms/*pathology; Age Factors ; Biopsy ; Carcinoma, Hepatocellular/diagnostic imaging ; Gingival Neoplasms/mortality ; Gingival Neoplasms/therapy ; Humans ; Immunohistochemistry ; Liver Neoplasms/diagnostic imaging ; Magnetic Resonance Imaging ; Sex Factors ; Tomography, X-Ray Computed ; Treatment Outcome

Background: Gingival metastasis from primary hepatocellular cancer (HCC) is rare, highly malignant, and generally has no distinct symptoms. Not performing a biopsy can lead to misdiagnosis. This article reports an 87-year-old male with gingival metastasis from HCC. To gain a better insight into this disease, we also conducted a literature review of 30 cases and discussed the clinical and pathological characteristics, diagnosis, treatment and prognosis of this unusual form of liver cancer.
Case Presentation: An 87-year-old man was hospitalized with a chief complaint of chronic constipation and diffuse lower extremity edema. His past medical history included a three-year hepatitis B infection and a cerebral infarction 17 years prior. Imaging examination detected a massive hepatocellular carcinoma in the right liver lobe and multiple metastases in the lungs. Oral examinations revealed a reddish, cherry-sized exophytic mass on the right upper gum. The mass was tentatively diagnosed as a primary gingival tumor and was ultimately confirmed by biopsy as a metastatic carcinoma originating in the liver. The patient decided, with his guardians, to receive palliative care and not to remove the mass. Unfortunately, the patient accidentally bit the mass open; profuse bleeding ensued and local pressure exerted a poor hemostatic effect. The patient's condition worsened, and he eventually died of multiple organ failure. We also performed a literature review and discussed 30 cases of gingival metastases from HCC. The findings indicated that these lesions affected males more than females, with a ratio of 6:1, and infiltrated the upper gingivae (63.1%) more than the lower gingivae (36.7%). Survival analysis indicated that the overall survival for patients with upper gingival metastasis was worse than for those with lower gingival metastasis, and patients receiving treatments for primary liver cancer or metastatic gingival tumors had better overall or truncated survival times.
Conclusion: Gingival metastasis from primary hepatocellular carcinoma is rare, and its diagnosis has presented challenges to clinicians. To avoid a potential misdiagnosis, a biopsy is mandatory regardless of whether a primary cancer is located. Early diagnosis and treatment for primary liver cancer or metastatic gingival lesions may improve survival expectations.

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K18010402 Guangdong Provincial People's Hospital Scientific Research Start-up Fund for Graduates; K17010402 Guangdong Provincial People's Hospital Scientific Research Start-up Fund for Graduates; 2018YFC2000300 National Key R&D Program of China

Keywords: Case report; Diagnosis; Gingival metastasis; Hepatocellular carcinoma; Literature review

Date Created: 20190916 Date Completed: 20200211 Latest Revision: 20200225

20231215

PMC6744688

10.1186/s12885-019-6020-7

31521125