title: Metastasis to the jaws as a first manifestation of hepatocellular carcinoma: report of a case and analysis of 41 cases.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Local metastasis is common but metastasis to the jaw is rare with 40 reported cases in the English language literature.
  
  
  METHODS
  We describe a case of a 54-year-old man who, for the past two months, had noticed a rapidly growing facial mass in the posterior mandibular area. The patient was known to be a hepatitis C virus carrier and suffered from liver cirrhosis but the presence of HCC was unknown.
  
  
  RESULTS
  The English language literature was searched for documented cases of HCC metastasis to the jaw, applicable data was evaluated. The literature analysis revealed 41 reported cases (including the present case). In most cases (81%) the jaw lesion was the only known metastasis at the time of HCC diagnosis. Clinical presentation occurred up to 2 years before discovery of the jaw metastasis. Patients with HCC jaw metastasis have a poor survival rate with an average of 6.1 months between diagnosis and death.
  
  
  CONCLUSIONS
  This study shows that an isolated jaw mass may be the initial presentation of HCC and therefore must be considered in the differential diagnosis, especially in the presence of known liver cirrhosis or chronic viral hepatitis.
authors.forename: Michael
authors.initials: M
authors.lastname: Pesis
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Oral and Maxillofacial Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Taicher
authors.affiliation: Neuroradiology Unit, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Gahl
authors.initials: G
authors.lastname: Greenberg
authors.affiliation: Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Hirshberg
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000556:secondary*; D002467:Cell Nucleus / Q000473:pathology; D003593:Cytoplasm / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D008940:Mitotic Index
keywords: Hepatocellular carcinoma; Jaw bone metastasis; Mandibular metastasis; Oral metastasis