PMC9619851_01
Photographs of patient before treatment demonstrating exophytic hard palate
mass (A); after treatment the mass is no longer grossly visible (B).
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A 32-year-old woman was referred to the oral surgery department at our institution for a painful hard palate mass (Figure 1A). On follow-up 1 month after radiotherapy was completed, she reported palliative benefit and demonstrated local tumor control along the hard palate where the tumor was no longer visible (Figure 1B).
(A) CT maxillofacial coronal image demonstrating tumor extending into the
left aspect of the nasal cavity from the palate (white arrow). (B) PET scan
demonstrating multifocal hypermetabolic masses within the cirrhotic liver.
Ascites is present (white arrow).. Abbreviations: CT, computed tomography; PET, positron emission
tomography.
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ALT (alanine transaminase) were unremarkable. Alkaline phosphatase was 113 IU/L. A maxillofacial computed tomography (CT) showed a 3.6 x 3.2 cm2 heterogeneous mass centered along the anterior aspect of the hard palate with penetration into the left nasal cavity (Figure 2A). Subsequent positron emission tomography (PET) CT skull to mid-thigh showed additional findings including cirrhotic appearing liver with ascites and multiple hypermetabolic hepatic masses (Figure 2B).
(A) Ulcerated hard palate metastatic tumor (hematoxylin-eosin, 40x). (B) Hard
palate tumor with trabecular and nesting patterns (hematoxylin-eosin, 100x).
(C) Hard palate tumor diffusely strongly positive for albumin in situ
hybridization (40x). (D) Hard palate tumor focally weakly positive for
arginase immunostain (100x). (E) Hepatocellular carcinoma with adjacent
liver tissue (hematoxylin-eosin, 100x). (F) Hepatocellular carcinoma with
trabecular pattern (hematoxylin-eosin, 400x). (G) Background liver with
cirrhosis (hematoxylin-eosin, 100x). (H) Metastatic pelvic tumor
(hematoxylin-eosin, 100x).
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Both biopsies demonstrated a proliferation of tumor cells with eosinophilic to clear cytoplasm in trabecular and nesting patterns (Figure 3E, 3F, 3H). The palate mass biopsy from the outside institution was reviewed and showed similar findings (Figure 3A-3B). AE1/AE3, keratin OSCAR, and CAM5.2; patchy weakly positive for arginase-1 (Figure 3D) and CK7; and negative for PAS-diastase, HepPar 1, glypican3, synaptophysin, chromogranin, DOG-1, S100, and p63. Albumin in situ hybridization (ISH) was strongly diffusely positive within the tumor cells (Figure 3C). The background liver showed cirrhosis with mild steatohepatitis and focal cholestasis (Figure 3G).