PMC5366209_01
Computerized tomography images of the involved organs. (a) The primary liver mass after the transarterial chemoembolization. (b) Multiple metastases to double lungs. (c and d) Multiple metastases to the brain.
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Computerized tomography (CT) scans of abdomen and chest exhibited an about 4 x 3 cm mass in the left lobe of liver and multiple nodules in two lungs (Figures 1(a) and 1(b)). CT scan of the head showed metastasized tumors (about 2.5 cm in diameter) with significant peritumoral edema in the right cerebellum and parietal and occipital brain lobes (Figures 1(c) and 1(d)).
The gingival tumor and jawbone images. (a) A reddish gingival tumor of soft texture, clear margin, and central mucosal ulceration on the right upper maxillary. (b) Radiography without local bony destruction.
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Physical examination showed a reddish 2 x 2 cm gingival nodule on the alveolar mucosa distal to the upper right first premolar, which was of soft texture, clear margin, and central mucosal ulceration, with swelling, mild pain, and occasional bleeding but no bony destruction by radiography (Figures 2(a) and 2(b)).
Histopathological staining findings. (a) H&E staining showing high nucleus/cytoplasm ratios and numerous abnormal mitotic divisions in sampled cells. (b-h) Immunohistochemical examinations revealing positive Hep Par 1 and Villin, 80% positive Ki-67, focused weak positive CK 7, and negative AFP, CK 19, and CK 20. Magnification x200.
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A dentist made a palliative excision of the nodule under local infiltration anesthesia and found much rotten fish-like discharge, which was confirmed as poorly differentiated carcinoma by histopathological and immunohistochemical (IHC) examinations, tending to be metastasized by HCC with positive hepatocyte paraffin 1 (Hep Par 1) and Villin, 80% positive Ki-67, focused weak positive cytokeratin 7 (CK 7), and negative AFP, CK 19, and CK 20 (Figures 3(a)-3(h)).