Tonsillar Metastasis of Hepatocellular Carcinoma: A Case Report and Review of the Literature

TL;DR

A rare case of liver cancer spreading to the tonsils highlights the need for early diagnosis and multidisciplinary treatment in advanced hepatocellular carcinoma.

Contribution

Reports a rare tonsillar metastasis of HCC and emphasizes the importance of considering such unusual presentations in clinical practice.

Findings

HCC metastasis to the tonsils was confirmed via biopsy and immunohistochemistry.

Local radiotherapy was effective in managing bleeding and reducing tumor size.

Tonsillar metastasis in HCC is rare but indicates a poor prognosis.

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.

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