Case Report
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 7, 2007; 13(33): 4526-4528
Published online Sep 7, 2007. doi: 10.3748/wjg.v13.i33.4526
Intractable bleeding from solitary mandibular metastasis of hepatocellular carcinoma
Shiang-Fu Huang, Ren-Chin Wu, Joseph Tung-Chieh Chang, Sheng-Chieh Chan, Chun-Ta Liao, I-How Chen, Chun-Nan Yeh
Shiang-Fu Huang, Chun-Ta Liao, I-How Chen, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan, China
Ren-Chin Wu, Department of Anatomic Pathology, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan, China
Joseph Tung-Chieh Chang, Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan, China
Sheng-Chieh Chan, Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan, China
Chun-Nan Yeh, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Chun-Nan Yeh, MD, Department of General Surgery, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kwei-Shan, Taoyuan 333, Taiwan, China. ycn@adm.cgmh.org.tw
Telephone: +88-63-3281200-3967 Fax: +88-63-3979361
Received: March 24, 2007
Revised: May 12, 2007
Accepted: May 21, 2007
Published online: September 7, 2007
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, Surgicel™, 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.

Keywords: Hepatocelluar carcinoma; Metastasis; Mandible; Radiotherapy; Bleeding