PDF(Pubmed)
Abstract：
A 63-year-old male with stage IV hepatocellular carcinoma (HCC), accompanied by lung and adrenal metastases, presented with oral bleeding. Physical examination disclosed bleeding from the tonsillar mass. A head and neck computed tomography identified a 2.4 cm enhancing lesion in the right anterior ethmoidal sinus, extending to the nasal region and medial orbit. Tonsillar mass biopsy confirmed HCC metastasis, immunopositive for Hepatocyte Paraffin 1 (HepPar1) and Arginase. He was treated with local radiotherapy (30 fractions). The unique presentation of severe bleeding from a tonsillar biopsy-proven HCC metastatic lesion underscores the rarity of head and neck involvement. Extrahepatic metastasis, particularly to the head and neck area likely due to hematogenous spread, may be a major independent predictor of poor outcomes in HCC patients. Local radiotherapy to achieve local hemostasis and reduce tumor bulk should be considered. In patients with known HCC having new oropharyngeal symptoms, HCC metastasis should be considered for a timely diagnosis. Despite its rarity, this manifestation signifies an unfavorable prognosis, reinforcing the imperative for a multidisciplinary approach to enhance therapeutic outcomes in these complex scenarios.
摘要：
一名63岁的男性患有IV期肝细胞癌（HCC），伴有肺和肾上腺转移，出现口腔出血.体格检查发现扁桃体肿块出血。头颈部计算机断层扫描发现右前筛窦有2.4厘米的增强病变，延伸到鼻区和内侧眼眶。扁桃体肿块活检证实HCC转移，肝细胞石蜡1（HepPar1）和精氨酸酶免疫阳性。他接受了局部放疗（30分）。扁桃体活检证实的HCC转移性病变严重出血的独特表现强调了头颈部受累的罕见性。肝外转移,尤其是头部和颈部区域，可能是由于血行扩散，可能是HCC患者预后不良的主要独立预测因素。应考虑局部放疗以实现局部止血和减少肿瘤体积。在已知肝癌有新的口咽部症状的患者中，HCC转移应考虑及时诊断。尽管它很罕见,这种表现表明预后不良，在这些复杂的情况下，加强多学科方法以提高治疗效果的必要性。
