PMC9938403_01
Orthopantomography showed generalized severe bone loss (a, b); undermining at the level of the left mandibular body and isodense image with defined limits and irregular edges; and conditioning a localized permeative pattern in the lower molar area left that extends from the crestal area of the residual ridge to the roof of the dental canal, generating erosion of the same (c-e).
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F1
Orthopantomography showed generalized severe bone loss; undermining at the level of the left mandibular body and isodense image with defined limits and irregular edges; conditioning a localized permeative pattern in the lower molar area left that extends from the crestal area of the residual ridge to the roof of the dental canal, generating erosion of the same; and tomographic signs suggestive of bone tumor lesion (Fig. 1).
The microscopic study showed atypical clusters of cells, which turned out to be hepatocytes owing to their sinusoid-like thin blood vessels with abundant cytoplasm, characteristic findings of liver cells (a, b). Immunohistochemistry revealed positive staining for human hepatocyte paraffin (HepPar1) antibody and glypican-3 diffuse positive (c, d).
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F2
This procedure showed atypical clusters of cells, which turned out to be hepatocytes owing to their sinusoid-like thin blood vessels with abundant cytoplasm, characteristic findings of liver cells (Fig. 2). These findings were consistent with metastatic HCC (Fig. 2).
Thorax and abdomen computed tomography with contrast revealed bone metastatic lesions at the level of the 2nd right rib, 1st left rib, and sixth and twelfth thoracic vertebrae (a, b) and a hepatic lesion with arterial enhancement and late venous lavage (c, d).
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F3
Cranial, neck, thorax, and abdomen computed tomography with contrast revealed a hepatic lesion with arterial enhancement and late venous lavage, as well as bone metastatic lesions at the level of the 2nd right rib, 1st left rib, and sixth and twelfth thoracic vertebrae (Fig. 3).