title: Intractable bleeding from solitary mandibular metastasis of hepatocellular carcinoma.
abstract: Hepatocellular carcinoma (HCC) metastasizes to the mandible is infrequently seen. Solitary bony metastasis to the mandible is rarer. The intractable bleeding caused by rupture of the metastatic HCC is challenging to clinicians. We present a case of a 74-year-old woman with HCC under control without progression for 3 years. Left facial swelling and episodes of bleeding developed recently and biopsy revealed a metastatic HCC. Computer tomography showed a large tumor in parapharyngeal space with evident mandibular ramus destruction. Bleeding occurred from the metastatic tumor but could not be controlled by electrocauterization, Surgical, tissue glue, and bone wax and angiographic embolization. Palliative radiotherapy (2400 cGy in 6 fractions) was tried and the intractable bleeding was successfully stopped after the radiotherapy. Because of the hypervascular and osteolytic nature of the solitary mandibular metastatic lesion, the bleeding was troublesome. Radiotherapy provided successful control of intractable bleeding from the metastatic tumor.
authors.affiliation: Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan, China.
authors.forename: Shiang-Fu
authors.initials: SF
authors.lastname: Huang
authors.forename: Ren-Chin
authors.initials: RC
authors.lastname: Wu
authors.forename: Joseph Tung-Chieh
authors.initials: JT
authors.lastname: Chang
authors.forename: Sheng-Chieh
authors.initials: SC
authors.lastname: Chan
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.forename: I-How
authors.initials: IH
authors.lastname: Chen
authors.forename: Chun-Nan
authors.initials: CN
authors.lastname: Yeh
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008334:Mandible / Q000473:pathology*; D008339:Mandibular Neoplasms / Q000150:complications / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D006472:Oral Hemorrhage / Q000209:etiology* / Q000532:radiotherapy
chemical_list: D014408:Biomarkers, Tumor