Hepatocellular Carcinoma Metastasis to the Tonsil: A Case Report of a Rare Entity

Hepatocellular carcinoma (HCC) is the most dominant malignant neoplasm of the liver and constitutes the majority of all primary malignancies. Most reported cases of HCC occur in the developing world and are mainly associated with chronic hepatitis B and C viruses. Both hematogenous and lymphatic spreading is common in HCC. Patients with HCC might manifest extra-hepatic metastases and the lungs are the most common potential site of metastatic deposits. Rare sites of metastatic disease have also been described. Oropharyngeal metastases of HCC are rare and there are few reports available in the literature. We report a rare case of extra-hepatic metastasis of HCC to the right tonsil in an 84-year-old patient. The clinical appearance of metastatic oral lesions could be easily underestimated, and diagnosis of the primary tumor might delay. A biopsy of the oral lesion is important for an accurate diagnosis. Metastasis in the oral cavity and oropharynx of an HCC is usually evidence of widespread disease and predisposes to an ominous prognosis.