Supplementary Material for: Mandibular metastasis as the first manifestation of hepatocellular carcinoma: Case report

Metastatic malignancies of the oral cavity are rare lesions, accounting for only 1–4% of all oral malignancies and can occur in the jaw bones, the oral soft tissues or even both. Although hepatocellular carcinoma is the most common primary hepatic tumor, in no more than 1% of the cases is there oral involvement. When metastatic tumor involves the oral cavity, the most frequent site is the posterior angle of the mandible. Histologically, hence, immunohistochemical markers are used for diagnosis. Glypican-3, HepPar1, CD34 are the markers that can be used to confirm the microscopic diagnosis of HCC. Very rarely, Hepatocellular carcinoma (HCC) metastasize to the oral cavity, and such cases have a poor prognosis due to delay in diagnosis. We present a 74-year-old male with a metastasis of HCC in left mandibular body as the first manifestation. Histologic examination confirmed metastatic hepatocellular carcinoma in the oral mucosa with immunohistochemical (IHC) markers. A review of pertinent literature was performed. Given the rarity of the disease, treatment principles are based mainly on retrospective series and case reports. We report an exceptionally unusual presentation with few cases (<70) reported in the literature, thus representing a diagnostic challenge.