Zygomatic bone metastasis as an initial presentation of hepatocellular carcinoma

Hepatocellular carcinoma is the most common type of primary liver cancer. It metastasizes via blood or through lymphatic dissemination, most comonly to the lungs, abdominal lymph nodes, and bones. Metastases to the bones of the head and neck region, however, are extremely uncommon. A 70-year-old male was presented with a mass in the left zygomatic region. After the incisional biopsy, the histopathologic and immunohistochemical analysis confirmed a metastasis of hepatocellular carcinoma. An abdominal computerized tomography (CT) scan  revealed a large primary tumor in the right liver lobe. To the best of our knowledge, this is the second case of an isolated zygomatic metastasis as an initial presentation of hepatocellular carcinoma. We also reviewed the literature regarding clinical and histopathologic characteristics of hepatocellular carcinoma that produced metastases to the zygomatic bone and the maxilla.